Health‐related quality of life and its determinants in children and adolescents born with oesophageal atresia

Aim: Following surgical correction in the neonatal period, patients born with oesophageal atresia have significant co‐morbidity, particularly in childhood. This study evaluates health‐related quality of life and its determinants such as concomitant anomalies and the presence of respiratory and/or gastro‐intestinal symptoms 6–18 years after repair of oesophageal atresia. Methods: Parents of 24 patients with oesophageal atresia completed the child health questionnaire for parents and 37 patients completed the child form. Gastro‐intestinal symptoms were assessed by a validated standardized reflux questionnaire. Results were compared with a healthy reference population. Results: Parents as well as patients themselves scored significantly lower on the domain general health perception. According to parents, general health perception was negatively affected by age at follow‐up and concomitant anomalies. Patients reported that reflux symptoms reduced general health perception. Conclusion: In this first study describing health‐related quality of life in children and adolescents born with oesophageal atresia, we demonstrated that general health remains impaired because of a high incidence of concomitant anomalies and gastrointestinal symptoms in patients with oesophageal atresia when compared with the healthy reference population.     

Barrett's oesophagus in children and adolescents

This paper describes 12 cases of Barrett's oesophagus (BE) selected out of a population of 364 refluxing children studied by X-ray, manometric, pH-metric, endoscopic, and bioptic methods in one single institution from 1986 to 1990. Their mean age was 14 years, the male-female ratio was 5:7, and all had had gastro-oesophageal reflux (GER) symptoms since infancy. At the time of diagnosis 9 (75 %) had vomiting, 6 (50 %) respiratory tract disease, 3 (25 %) hæmorrhage, and 1 (8 %) peptic stenosis. Seven were cared for in special institutions for brain-damaged patients and 2 had been operated upon for oesophageal atresia at birth. Lower oesophageal sphincter pressure was very low in 8 out of 9 children studied and propulsive peristalsis was markedly decreased. Excessive acid exposure was documented in 8 out of 10 patients studied and simultaneous gastric and oesophageal pH-monitoring demonstrated massive duodeno-gastric alkaline reflux in 3 (2 of them with normal oesophageal pH studies). Histological and histochemical studies, including special mucin staining revealed that the columnar-lined epithelium was of the fundic type in 2 cases, the junctional type in 7, and the specialised type in the remaining 3. Helicobacter pylori was found in the mucosa of 8 patients (in massive amounts in 3). All patients had a Nissen fundoplication with good results in terms of disappearance of the GER symptoms. The present series confirms that BE should be looked for endoscopically in children with GER and supports the hypothesis that long duration of GER and excessive acid-alkaline chemical exposure of the oesophageal lining contribute to the pathogenesis of mucosal changes. The role of H. pylori is not clear, but its intriguing presence in the majority of our cases indicates that further research along these lines is warranted.     

Esophageal adenocarcinoma and Barrett esophagus in a neurologically impaired teenager

Esophageal adenocarcinoma (EAC) accompanied by Barrett esophagus (BE) is rare in patients younger than 20 years old. EAC in the upper esophagus is also rare. We report a rare case of EAC with BE that developed in the upper esophagus after chronic, untreated gastroesophageal reflux disease in a neurologically impaired teenager. A 19‐year‐old neurologically impaired man underwent endoscopy for evaluation of dysphagia and vomiting, and was diagnosed with EAC with BE. He underwent transthoracic esophagectomy, extensive lymph node dissection, and cervical esophagogastric anastomosis, but the prognosis was poor. Pathology indicated poorly differentiated adenocarcinoma with BE.     

Asthma and overweight are associated with symptoms of gastro-oesophageal reflux

AIM: To explore the prevalence of symptoms suggestive of gastro-oesophageal reflux disease (GERD) in asthmatics and controls, and to control for the possible effect of overweight. METHODS: The prevalence of GERD symptoms was assessed using a questionnaire about reflux symptoms in children with asthma (n=872, mean age 10.4 y, 65% males) compared to non-asthmatic controls (n=264, mean age 10.8 y, 48% males), and a symptom score was calculated. The association between GERD symptoms and overweight (age-adjusted BMI > 25) was assessed independently. RESULTS: A positive reflux symptom score was found in 19.7% of the asthmatics compared to 8.5% of the non-asthmatic control group (odds ratio (OR) 2.6, 95% CI 1.7-4.2). Overweight children reported GERD symptoms more frequently than children with normal weight (OR 1.8, 95% CI 1.2-2.6). Asthma and obesity remained significant predictors when analysed simultaneously by logistic regression analysis. One hundred and fifty-two children with asthma consented to an oesophageal pH study, and an abnormal pH study result (reflux index > 5.0) correlated positively with overweight (OR 4.9, 95% CI 2.2-11.0). CONCLUSION: The prevalence of symptoms associated with gastro-oesophageal reflux was increased in children with asthma and in overweight children. Overweight and asthma were independently associated with GERD symptoms, and overweight did not explain the higher frequency of GERD in asthma patients.     

Inflammation of the gastric cardia in children with symptoms of acid peptic disease

OBJECTIVES: To assess the severity and causes of inflammation of the gastric cardia in children undergoing endoscopy for symptoms of acid peptic disease. STUDY DESIGN: Patients undergoing upper gastrointestinal endoscopy for symptoms of acid peptic disease had biopsies from gastric cardia, gastric, and esophageal sites, and 24-hour intraesophageal pH monitoring. Gastric cardia was defined at endoscopy as the anatomic zone from the squamocolumnar junction to 0.5 cm below it. Severity of gastric cardia inflammation was scored 0 to 9 according to densities of inflammatory cells and epithelial abnormalities in surface and pit epithelium. A score > or =2 was considered positive. RESULTS: Forty-seven children (median age, 6.5 years; range, 3-15) had Helicobacter pylori infection, gastroesophageal reflux disease (GERD), or both. In 22 patients, H pylori was detected in cardiac biopsies by rapid urease test and histology; it was detected also in the corpus and antrum in only seven of the 22. No patient had H pylori in gastric corpus/antrum without having the organism at the cardia as well. In 12 H pylori-positive patients, GERD was also diagnosed. Twenty-five patients had GERD and no H. pylori infection. Severity score was 3.8+/-0.8 in the H pylori group and 2.08+/-0.9 in the GERD alone group (P<.001); however, there was no difference in reflux index (24-hour % of gastroesophageal reflux) between the two groups. In neither group was correlation found between reflux index and severity score (H pylori, r=0.22; GERD alone, r=0.31; NS) nor between cardia inflammation and esophagitis grade (H pylori, r=0.37; GERD alone, r=0.22; NS). CONCLUSIONS: In children with symptoms of acid peptic disease, inflammation of the gastric cardia does occur. It is more severe when the cardiac zone is infected with H pylori than in its absence. Of major practical significance is the finding that the gastric cardia is a highly sensitive site for the detection of H pylori infection.     

Gastroesophageal reflux disease and Helicobacter pylori infection in neurologically impaired children: inter-relations and therapeutic implications

BACKGROUND: The aim of this retrospective study was to assess the relationship between Helicobacter pylori infection and gastroesophageal reflux disease in a high-risk population of children. METHODS: Forty-three neurologically impaired pediatric patients with H. pylori had upper gastrointestinal endoscopy between 1990 and 2000. Infection was confirmed by positive H. pylori culture or by identification of organisms in gastric biopsy specimens (fundus, n = 2; antrum, n = 3). Reflux esophagitis was diagnosed by ulceration of the esophageal mucosa at endoscopy. Four to 6 weeks after the completion of antibiotic treatment of H. pylori, a second endoscopy was performed and the gross appearance of the esophagus was recorded. RESULTS: At the first endoscopy, esophagitis was noted in 14 of 43 patients. After treatment, H. pylori infection was eradicated in all 14 patients with esophagitis but in only 19 of 29 (66%) of those with normal esophagus (P = 0.01). Esophagitis was still present in 4 of 14 (29%) patients who had esophagitis at the first endoscopy. Persistent esophagitis was only related to the presence of esophagitis before treatment (P = 0.02). In 29 patients with a normal esophagus at the first endoscopy, only one case of esophagitis was observed after H. pylori eradication. CONCLUSION: The data suggest that treatment of H. pylori infection should be considered in children with concomitant GERD, and such treatment is unlikely to either induce or exacerbate peptic esophagitis.     

Bile and acid reflux in the pathogenesis of reflux oesophagitis in children

Aim:   The aim of this study was to investigate the role of bile and acid reflux in the pathogenesis of reflux oesophagitis (RE) in children.
Methods:   A total of 44 patients aged 5–17 years with gastro-oesophageal reflux symptoms were enrolled. Simultaneous 24-h oesophageal Bilitec 2000 (Medtronic Instruments, Minneapolis, MN, USA) bilirubin monitoring and pH monitoring, in biopsy of oesophageal mucosa by gastro-endoscopy, were performed in all patients.
Results:   According to the diagnostic criteria of pathological acid reflux and pathological bile reflux, 10 of 44 cases (22.7%) had acid reflux, 10 (22.7%) had isolated bile reflux, 16 (36.4%) had mixed acid and bile reflux, and the other eight (18.2%) had no reflux. Significant difference was observed in the ratio of different patterns of reflux between the RE group (26 cases) and the non-erosive reflux disease (NERD) group (18 cases) (χ² = 9.096, P  < 0.01). All the parameters of acid reflux in the RE group were higher significantly than that in the NERD group ( P  < 0.05 or P  < 0.01). A total of 20 out of 26 cases (76.9%) with RE had oesophageal acid reflux as against six out of 18 cases (33.3%) in patients with NERD ( P  < 0.01). The difference of each parameter of bile reflux had not reached significance between the two groups.
Conclusions:   Mixed reflux is the predominant form of reflux in the causation of oesophageal mucosal injury in children. Isolated bile reflux also plays a role in the development of RE, although only in patients without acid reflux.     

胆汁和胃泌素在小儿胃食管反流病中的作用

目的：探讨酸和胆汁反流在小儿胃食管反流病(GERD)中的发生情况以及胆汁和胃泌素在小儿GERD中的作用。方法：根据内镜检查结果将GERD分为反流性食管炎(RE)组和非糜烂性反流病(NERD)组,共检测42例。同时应用便携式食管pH监测仪及胆汁监测仪对其进行24hpH监测及胆汁联合监测,对相应病例采用放射免疫测定法进行空腹血清胃泌素(GS)测定,同期检测13例无胃食管反流症状并排除了消化道及严重全身器质性疾病的儿童作为对照。结果：42例患儿中24例为RE(内镜检查存在食管下段黏膜充血等病损),18例为NERD(内镜检查黏膜正常)。GERD患儿pH<4及胆红素吸收值≥0.14的总时间百分比、酸及胆汁反流的总次数和反流>5min的次数均明显高于正常对照组(P<0.05),RE组的食管酸暴露时间(pH<4)及胆红素吸收值≥0.14的时间百分比较NERD组明显增高(P<0.05)。NERD组6例(33.3%)、RE组16例(66.7%)出现酸和胆汁混合反流(P<0.01)。RE组和NERD组血清GS浓度均明显高于正常对照组(P<0.01,P<0.05),且RE组的血清GS浓度明显高于NERD组(P<0.05)。结论：小儿GERD中以混合反流为主,胆汁反流在小儿GERD的发病中起一定作用,GS的分泌异常可能参与了小儿GERD的发病过程。在小儿GERD的发展过程中,GS和胆汁反流可能起正性协同作用。     

Contribution of fibreoptic endoscopy to diagnosis and management of children with gastro-oesophageal reflux

Endoscopic and radiological examination was performed in 53 children with gastro-oesophageal reflux. There was fair agreement between endoscopic and radiological findings. Most patients showed either a normal or an erythematous oesophageal mucosa at endoscopy and these patients became asymptomatic on conservative therapy. 7 children presented destructive changes of the oesophageal mucosa with severe pathological abnormalities. Though their symptoms improved on conservative therapy, 5 required operation because of persistence or deterioration of mucosal damage. Endoscopic and pathological changes returned to normal after operation. Retrospective examination of data led to the definition of 'high risk factors' in this condition.     

Contribution of fibreoptic endoscopy to diagnosis and management of children with gastro-oesophageal reflux.

Endoscopic and radiological examination was performed in 53 children with gastro-oesophageal reflux. There was fair agreement between endoscopic and radiological findings. Most patients showed either a normal or an erythematous oesophageal mucosa at endoscopy and these patients became asymptomatic on conservative therapy. 7 children presented destructive changes of the oesophageal mucosa with severe pathological abnormalities. Though their symptoms improved on conservative therapy, 5 required operation because of persistence or deterioration of mucosal damage. Endoscopic and pathological changes returned to normal after operation. Retrospective examination of data led to the definition of ''high risk factors'' in this condition.     

Gastric emptying with gastro-oesophageal reflux.

The time taken for gastric emptying of a liquid (milk) or a semi-liquid (pudding) meal was evaluated in 477 infants and children. These patients were referred for suspected gastro-oesophageal reflux and underwent gastro-oesophageal scintigraphy, prolonged oesophageal pH study, manometric evaluation of the lower oesophageal sphincter pressure, and fibreoptic endoscopy. No difference in gastric emptying was observed in children aged under 3 years, regardless of the presence or absence of the gastro-oesophageal reflux, the pressure of the lower oesophageal sphincter, or the presence of oesophagitis. In children over 6 years, however, gastric emptying was significantly delayed in those presenting with reflux compared with those without reflux; in children over 3 years there was slower gastric emptying in those with a decreased lower oesophageal sphincter pressure compared with those with higher pressure and in those with overt oesophagitis compared with those without oesophagitis. This study suggests that gastro-oesophageal reflux is more severe in childhood than in infancy, probably due to more complex motor disorders affecting the gastric fundus as well as lower oesophageal sphincter function.     

Reduced quality of life in children with Gastro‐oesophageal reflux disease

Aim: To assess self‐reported Quality of life (QoL) in children with Gastro‐oesophageal reflux disease (GORD) aged 5–18 and compare this with both disease and healthy control children in a prospective consecutive sample. Methods: All children attending a tertiary paediatric gastroenterology clinic from February 2009 to May 2009 with GORD, chronic constipation and inflammatory bowel disease (IBD) were asked to complete the validated PedsQL generic QoL assessment (self‐report) at their clinic appointment. The PedsQL considers physical, emotional, social and school domains and is scored from 0 to 100. Healthy children were also recruited from the same site. Groups were compared using the independent samples Student’s t‐test. Results: A total of 184 children completed the assessment [103 (56%) male, mean age 10.7 years ± 3.3] including 40 children with GORD, 44 with chronic constipation, 59 with IBD and 41 healthy children. QoL was significantly lower in the GORD group compared with both children with IBD (74 vs. 82) and healthy children (74 vs. 84), and was comparable to that of children with chronic constipation (74 vs. 74). Conclusions: Self‐reported QoL in children with GORD attending a tertiary paediatric gastroenterology clinic is significantly reduced compared with both healthy children and children with IBD.     

Diagnosis and management of gastroesophageal reflux disease (GERD): An indian perspective

Need and Purpose

The scarcity of literature and lack of published guidelines on gastroesophageal reflux disease (GERD) from India, have necessitated this review.

Methods

A literature search in PubMed was conducted with regard to epidemiology, clinical features, investigation and management of GERD in children. English language studies published full over the last 20 years were considered and relevant information was extracted.

Results

Nearly half of all healthy babies regurgitate at least once a day by 4 months of age and this subsides in 90% of them by 1 year. In contrast, GERD prevalence increases with age and by adolescence it is similar to adults (20%). While regurgitation in infancy does not need investigation or therapy, ‘empirical’ proton pump inhibitor (PPI) for 4 weeks is justified in older children with classical GERD symptoms. There is no gold-standard investigation for GERD. A pH study with or without impedance is useful in extraesophageal manifestations and endoscopy in esophagitis. Proton pump inhibitors (PPI) play a pivotal role in the management of GERD and its long-term use has been shown to be safe in children. Antireflux surgery plays a minor role due to, its associated morbidity and high failure rate, especially in the high risk group who needs it most.

Conclusions

Regurgitation in infancy need not be investigated unless there are warning features. Empirical PPI therapy is justified in older children and adolescents with typical reflux symptoms. pH study in extraesophageal manifestations and endoscopy for esophagitis are the investigations of choice. PPI is the mainstay of therapy in GERD.     

Reflux strictures of the oesophagus in children: personal experience with preoperative dilatation followed by anterior funduplication

Introduction Oesophageal surgery for reflux stricture is as challenging in adults as in the paediatric age group. Several management protocols, both medical and surgical, are currently proposed, such as bougienage, funduplication without dilatation, funduplication with pre– and postoperative dilatation, resection and interposition, and pharmacological therapy. However, reported results are not univocal. The aim of this work is to demonstrate that preoperative treatment with H2-antagonist combined with oesophageal dilatation and followed by anterior funduplication (Boix-Ochoa procedure with elongation of intraabdominal segment of the oesophagus) is a long-term, effective treatment for reflux stricture in children. It provides a tension free repair and an adequate protection to reflux, thus, preventing recurrences.Materials and methods In the last five years we observed oesophageal stenosis in 10 out of 49 children, operated for gastroesophageal reflux (mean age 62.9 months, range 12–156 months). All children underwent treatment with H2-antagonist (Ranitidine) and prokinetic agent (Cisapride), followed by oesophageal dilatations (mean 2.8, range 2–4 cycles) with Savary-Gillard dilators. An open anti–reflux procedure was performed (9 Boix-Ochoa and 1 Nissen) on children where a 9 mm endoscope passed easily through the oesophageal lumen. The pre and postoperative evaluation of all patients included symptoms assessment, esophagogram and endoscopy.Results Results were satisfactory in 9 patients. Only one patient where a Nissen wrap was performed, incomplete relaxation was documented radiologically. The patient required several dilatations for residual dysphagia before reaching a symptom free status. All other patients had an average follow-up of 38 months (range, 5 months to 5 years) with relief from dysphagia and no recurrence of stricture. Radiological controls showed good oesophageal lumens, with normally positioned neocardias, opening regularly during barium passage with no sign of reflux. Multiple biopsies from endoscopic controls confirmed complete relief from oesophageal stricture but persistence of Barrett's mucosa.Conclusions Our treatment of choice for reflux stricture is preoperative pharmacological therapy followed by series of dilatation with Savary-Gillard dilators till oesophagus is adequately dilated. Antireflux surgery is mandatory when a stricture is observed. We prefer a Boix-Ochoa funduplication with extensive transhiatal mobilization of thoracic oesophagus. This results in a "tension free" fundoplication even when brachioesophagus is present. The procedure appears to be physiological for pediatric patients and in our hands was free from recurrences.     

Delayed gastric emptying in gastroesophageal reflux disease: the role of malrotation

The association between gastroesophageal reflux (GER) and intestinal malrotation (IM) has been well described. Delayed or impaired gastric emptying in IM is thought to be a contributing factor in the development of gastroesophageal reflux disease (GERD). The current study assessed the role of malrotation in delayed gastric emptying in children with GERD. We also evaluated the interactions between GERD, malrotation, gastric pH abnormalities, and gastric dysmotility. Sixty-seven patients between 1 and 5 years of age (mean 3.08±1.2) and with symptoms of GER, such as emesis, reactive or recurrent lung disease, and/or growth retardation, were studied in 2001–2005. Upper and lower gastrointestinal contrast studies were performed for the diagnosis of malrotation. Gastric motility was evaluated with a liquid gastric emptying protocol. GER was documented by upper gastrointestinal studies, scintigraphy, and/or 24-h pH monitoring. In our series of 44 children with GERD, there was an unexpectedly high incidence of IM: 54.5% (24/44). IM has previously been known to occur in 25% of patients with GERD. GERD was found in 24 (82.7%) of 29 patients with IM. Mean nuclear gastric emptying (MNGE) was 51.6±8.04 min in patients with isolated GERD and 96.6±20.5 min in children with IM and GERD. There was a statistically significant difference in MNGE time (p<0.05) between children with primary GERD and in those with GERD and IM. Esophageal pH monitoring showed that mean fraction time below pH 4 was 7.06±1.1% in patients with isolated GERD and 14.7±4.1% in patients with IM and GERD. GERD is common in children between 1 and 5 years old. Using gastric emptying studies and esophageal pH monitoring, we have shown that gastric dysmotility and esophageal pH abnormalities are highly prevalent, especially in children with malrotation compared with children with isolated GERD. These findings suggest that malrotation is an important factor responsible for delayed gastric emptying in GERD. Hence, we recommend that all infants and children with GERD and delayed gastric emptying undergo careful evaluation for malrotation.     

Is there a relationship between Helicobacter pylori infection and erosive reflux disease in children?

Aim:  The aim of this study was to investigate the relationship between Helicobacter pylori infection and erosive reflux disease in children.
Methods:  A total of 206 children [mean age 8.4 ± 4.9 (0.16–18) years] who underwent diagnostic upper endoscopy were tested for H. pylori infection between 2002 and 2005 and the relationship between H. pylori infection and gastro-oesophageal reflux disease was investigated retrospectively. Endoscopic and histopathological findings were examined retrospectively. When reflux-related oesophageal damage was identified as a result of the histological examination of endoscopic biopsy samples collected from distal oesophagus, the patients were diagnosed with gastro-oesophageal reflux disease and divided into two groups: those with macroscopic erosions or ulceration constituted the erosive oesophagitis group; those without constituted the non-erosive reflux disease group.
Results:  Prevalence of H. pylori infection was 31.3% in the patients with gastro-oesophageal reflux disease and 36.7% in the control group (p > 0.05). Prevalence of erosive oesophagitis was found to be 23.8% in the patients with H. pylori infection and 41.3% in those without (p > 0.05).
Conclusion:  No negative significant association was found between the prevalence of H. pylori infection and erosive oesophagitis. Presence of H. pylori infection did not influence the severity of oesophagitis either.     

Oesophageal pH monitoring and reflux oesophagitis in irritable infants

Acid reflux and/or oesophagitis may be responsible for inconsolable crying in infants. We evaluated prospectively the presence of acid reflux disease, oesophagitis and the accuracy of pH monitoring in the prediction of oesophagitis in a population of irritable infants. A 24-h oesophageal pH monitoring with a glass electrode and an upper gastro-intestinal tract endoscopy with grasp biopsies were performed in 60 irritable infants, aged 1 to 6 months, not responding to cows milk elimination. The 24-h oesophageal pH monitoring was considered abnormal in 40/60 (66%) babies and histological oesophagitis was present in 26/60 (43%). In the infants with histological oesophagitis, the reflux index (% of the investigation time with a pH <4.0) was >5% in 18/26 (69%). Histology of the oesophagus was normal in 22 of the 40 (55%) infants with an abnormal pH monitoring. The mean reflux index in the group with oesophagitis (12.20%) was significantly higher than in the group with normal histology (8.74) ( P =0.036), although there was an important overlap. The sensitivity and specificity to predict oesophagitis with a reflux index of 5.0% or more was 69.2 and 35.3, respectively. There was not a reflux index which could be related to a clinically useful sensitivity and specificity to predict oesophagitis. Conclusion:acid gastro-oesophageal reflux disease and/or histological oesophagitis were diagnosed in 66% and 43% of irritable infants, respectively. There was no relation between symptoms and abnormal pH metry or oesophagitis; however, the reflux index does not accurately predict oesophagitis and normal histology does not accurately exclude acid gastro-oesophageal reflux disease. Oesophageal pH monitoring and endoscopy provide additional information.Abbreviations GOR gastro-oesophageal reflux - RI reflux index     

儿童原发性十二指肠胃反流对胃黏膜损伤的作用

目的 观察儿童原发性十二指肠胃反流(DGR)对胃黏膜的损伤作用,并初步探讨DGR与临床症状、幽门螺杆菌感染和胃内酸度的关系.方法 对81例因腹痛、饱胀、恶心、呕吐等上消化道症状就诊的患儿,进行临床症状评分、胃镜检查、胃窦黏膜组织病理学检查和24 h胃内胆红素监测,其中51例同步行24 h胃内pH监测.以胆汁反流总时间百分比作为胆汁反流程度的指标.根据胃窦黏膜的胃镜下改变以及组织病理学特征变化有无进行分组,分别比较2组的胆汁反流程度.并对胃内胆汁反流与临床症状评分、胃内酸度以及Hp感染等进行相关性分析.结果 胃窦黏膜有充血者[17.1%(0.5%～53.2%)]较无充血者[6.5%(0～58.6%)](Z=-1.980),有黄染者[19.8%(0.5%～58.6%)]较无黄染者[8.8%(0-38.0%)](Z=-2.956),胆汁反流总时间百分比高,差异均有统计学意义(P＜0.05或0.01);胃窦黏膜组织病理学检查,有肠化组胆汁反流总时间百分比[29.0%(1.9%～58.6%)]较无肠化组[14.3%(0～53.7%)]长,差异有统计学意义(Z=-2.026,P＜0.05).有慢性炎症组与无慢性炎症组、有活动性组与无活动性组相比,胆汁反流程度差异无统计学意义(P＞0.05).胆汁反流严重度与饱胀症状正相关(r=0.258,P＜0.05),与Hp感染(r=0.016)和胃内酸度(r=0.124)元明显相关性(P均＞0.05).结论 原发性DGR可致儿童胃窦黏膜损伤,胃镜下主要表现为胃窦黏膜充血和黄染,病理组织学变化上与肠上皮化生有关,与炎症细胞浸润无关.DGR与Hp感染和胃内酸度均无关,DGR可能是一个独立的致病因素,与Hp感染和胃酸一起共同对胃黏膜造成损伤.     

Gastroesophageal reflux disease and dental erosion in children

Recurrent exposure to gastric acid as in children with bulimia and gastroesophageal reflux disease (GERD) may contribute to dental erosion. We performed a prospective study to evaluate the presence of GERD and dental erosions in children with primary and permanent dentition. Children undergoing elective endoscopy for possible GERD (n = 37) underwent evaluation of their teeth for the presence, severity, and pattern of erosion and stage of dentition: 24 patients had GERD. Dental erosions were identified in 20; all had GERD. Erosion patterns showed more involvement of the posterior teeth. Many affected patients had primary dentition.     

Motor disorders of the oesophagus in gastro-oesophageal reflux.

Mechanisms of gastro-oesophageal reflux were studied by oesophageal manometry and pH monitoring in 33 children: nine controls, 15 with gastro-oesophageal reflux alone, and nine with reflux oesophagitis. A total of 122 episodes of reflux were analysed in detail: 82 (67%) were synchronous with swallowing and 40 (33%) asynchronous. Infants with trivial symptoms had gastro-oesophageal reflux synchronous with swallowing, whereas those with serious symptoms had slower acid clearance and asynchronous reflux. There were significant differences in lower oesophageal sphincter pressure and amplitude of oesophageal contractions between controls and patients with both gastro-oesophageal reflux and reflux oesophagitis. In reflux oesophagitis there was a decrease in lower oesophageal sphincter pressure and the contractions had a bizarre waveform suggesting a neuropathic process.