食管裂孔疝患儿手术前后食管功能的研究

目的　为探讨食管裂孔疝 (hiatalhernia ,HH)病理生理机制 ,了解HH患儿手术前后的食管功能改变及不同类型HH食管动力压力改变的特点。方法　对 38例经钡餐造影确诊的HH患儿(其中滑动型 17例、食管旁型 10例、混合型 11例 )进行手术前后 2 4小时食管pH监测和食管腔内动力压力测定。结果　食管裂孔疝患儿术前食管pH监测有明显的异常胃酸反流 ;食管动力压力异常表现为食道下段括约肌压力 (LESP)下降 ,下食管括约肌总长度 (LESL)变短 ,双峰波型出现及呼吸反转点消失。不同类型的食管裂孔疝食管动力压力的改变也有所不同 ,滑疝以双峰波型为主要改变 ;食管旁疝以呼吸反转点消失为主要改变 ;而混合疝以呼吸反转点消失及双峰波型为主要改变 ;LESL变短各类型疝都明显存在。术后食管pH监测各项指标均显著下降 ;食管腔内动力压力测定双峰波型消失 ,呼吸反转点出现 ,LESL增加 ,但LESP下降仍存在。结论　伴临床症状的HH患儿均存在明显的病理性胃酸反流 ;食管动力压力改变由于类型的不同而有所不同 ,LESP在HH反流的发生和抗反流的功能上不起重要作用 ,而LESL不足 ,尤其是腹内食管段长度不足甚至消失是HH发生反流的主要原因。     

食管裂孔疝患儿手术后食管功能的研究

目的 为探讨食管裂孔疝（hiatal hernia,HH）病理生理机制，了解HH患儿手术前后的食管功能改变及不同类型HH食管动力压力改变的特点。方法 对38例经钡餐造影确诊的HH患儿（其中滑动型17例、食管旁型10例、混合型11例）进行手术前后24小时食管pH监测和食管腔内动力压力测定。结果 食管裂孔疝患儿术前食管pH监测明显的异常胃酸反流；食管动力压力异常表现为食道下段括约肌压力（LESP)下降，下食管括约肌总长度（LESL0）变短，双峰波型出现及呼吸反转点消失。不同类型的食管理解孔疝食管动力压力的改变也有所不同，滑疝以双峰波型为主要改变；食管旁疝以呼吸反转点消失为主要改变；而混合疝以呼吸反转点消失及双峰波型为主要改变；LESL变短各类型疝都明显存在。术后食管pH监测各项指标均显著下降；食管腔内动力压力测定双峰波型消失，呼吸反转点出现，LESL增加，但LESP下降仍存在。结论 伴临床症状的HH患儿均存在明显的病理性胃酸反；食管动力压力改变由于类型的不同而有所不同，LESP在HH反流的发生和抗反流的功能下不起重要作用，而LESL不足，尤其是腹内食管段长度不足甚至消失是HH反流的主要原因。     

小儿慢性咳嗽与胃食管反流的关系

目的探讨小儿慢性咳嗽与胃食管反流(GER)的关系。方法对170例慢性咳嗽患儿进行24h食管pH监测,32例无症状小儿作为对照。结果病例组各项食管酸反流指标如酸反流次数、反流≥5min次数、最长反流时间、酸性反流指数及Boix-Ochoa综合评分均高于对照组,差异有统计学意义(Z=3.025～4.661,P均<0.01)。根据GER诊断标准,病例组GER检出率为37.1%(63/170例),高于对照组的3.1%(1/32例),差异有统计学意义(χ2=14.327,P<0.01)。2个月～1岁组、～3岁组和>3岁组的GER阳性率分别为47.4%(27/57例)、41.5%(17/41例)和26.4%(19/72例),差异有统计学意义(χ2=6.453,P<0.05)。结论GER与小儿慢性咳嗽关系密切,尤其是3岁以下的婴幼儿;食管pH监测对于明确小儿慢性咳嗽的原因有重要的临床价值。     

小儿慢性咽喉炎与胃食管反流的关系

目的探讨小儿慢性咽喉炎与胃食管反流（GER）的关系。方法对37例慢性咽喉炎患儿进行24h食管pH监测,30例无症状儿作为对照。结果病例组各项食管酸反流指标如酸反流次数、反流≥5min次数、最长反流时间、酸性反流指数及Boix-Ochoa综合评分均高于对照组,差异有统计学意义（Z=2.673～4.144,P均〈0.01）。病例组GER检出率（40.5%,15/37例）高于对照组（3.3%,1/30例）,差异有统计学意义（χ^2=12.617,P〈0.01）。结论GER与小儿慢性咽喉炎关系密切;对常规治疗效果差的慢性咽喉炎患儿要考虑到GER的可能,及时进行有关检测。     

近端食管胃酸反流与胃食管反流患儿呼吸道症状的关系

目的了解胃食管反流(GER)患儿近端食管胃酸反流与呼吸道症状发生的关系。方法采用食管双pH动态监测法，对31例单纯性呕吐、23例伴有反复呼吸道症状的GER患儿同时监测食管近端和远端pH值的变化，以35例健康儿作为对照组。结果单纯呕吐组远端食管各项酸反流指标、近端食管酸反流指标除最长反流时间外均大于对照组，差异有显著性；呼吸道症状组远端食管、近端食管各项酸反流指标均大于对照组，差异有显著性；但单纯呕吐组与呼吸道症状组相比较，无论在近端食管还是在远端食管，各项指标的差异无显著性；病例组远端食管各项酸反流指标均大于近端食管，差异有显著性。结论近端食管酸反流并不是GER患儿发生呼吸道症状的主要因素，而远端食管酸反流是小儿GER的主要反流形式。     

24h食管pH监测在婴儿喘息性疾病中的应用

目的探讨24 h食管pH监测在婴儿喘息性疾病中的应用。方法对74例喘息性疾病婴儿进行24 h食管pH监测,监测指标包括食管pH<4.00的次数、反流时间≥5 min的次数、最长反流时间、卧位pH<4.00的时间占总监测时间的百分比以及Biox-Ochoa评分;对所有喘息患儿按照病情分为持续性喘息组和一般喘息组,比较2组24 h食管pH监测情况;将其中有病理性胃食管反流(GER)的40例患儿随机分为治疗组和对照组。对照组给予常规抗炎、平喘治疗,治疗组在抗炎、平喘治疗基础上加用抗GER治疗。比较2组患儿住院时间和肺部啰音消失时间?峁?4例喘息性疾病患儿病理性GER发生率为54.0%。其中持续性喘息组病理性GER发生率(69.4%),显著高于一般喘息组(39.5%);持续性喘息组各项反流指标均高于一般喘息组(Pa<0.01)。治疗组患儿住院时间、肺部啰音消失时间均较对照组明显缩短,差异均有统计学意义(Pa<0.01)。所有患儿在24 h食管pH监测中未出现严重不良反应,无终止监测的发生。结论喘息性疾病患儿病理性GER发生率高,持续性喘息患儿发生率更高。伴有病理性GER的喘息患儿经抗GER治疗后效果明显。24 h食...     

新生儿胃食管反流病的治疗进展

<正>胃食管反流(gastroesophageal reflux,GER)是指胃内容物反流至食管,可分为生理性反流和病理性反流。新生儿由于存在食管下端括约肌张力低下、食管清除能力较弱、胃排空延迟等生理特点,导致约70%~85%的新生儿在出生后会出现胃食管反流现象,其中有95%的患儿在无任何治疗干预的情况下可在1岁左右自行缓解[1]。病理性GER,又称胃食管反流病     

婴幼儿胃食管反流与呼吸道感染的关系探讨

目的探讨婴幼儿阶段胃食管反流与呼吸道感染的关系。方法用便携式24h食管pH监测仪记录食管下端pH值变化。观察组89例,平均年龄(10.5±0.9)个月,系因下呼吸道感染在呼吸科病房住院患儿,符合下述3条件之一①3个月内有下呼吸道感染史≥1次;②咳嗽喘息经过治疗≥半个月仍不愈;③溢乳史。对照组为26例健康儿,平均年龄(13.7±2.1)个月。结果观察组5项反流指标均高于对照组,差异有显著性(P均<0.001)。观察组病理性GER的检出率为79.8%(71/89例),显著高于对照组(χ2=49.554,P<0.01)。呼吸道感染合并GER的患儿在总反流次数、反流时间≥5min的次数和最长反流时间上婴儿高于幼儿,差异有显著性(P<0.01或<0.05);总pH<4时间百分比和综合评分也是婴儿较幼儿高(P<0.01)。呼吸道感染合并GER的患儿体重偏重眼体重大于第80百分位(P80)演占40.8%(29/71例)。婴儿GER患儿中体重偏重者占一半,与幼儿GER相比,差异有显著性。结论在婴儿期胃食管反流症状较幼儿期常见,溢乳和体重偏重有关;婴幼儿时期胃食管反流病与反复呼吸道感染、呼吸道炎症不愈以及部分哮喘有关。     

儿童重症肺炎与胃食管反流关系的临床研究

目的 了解重症肺炎患儿胃食管反流(gastroesophageal reflux,GER)的发生及其影响因素.方法 对2009年2月至2011年2月于我科PICU就诊的确诊为重症肺炎患儿25例(肺炎组)和正常儿童10例(对照组)进行连续食管pH监测,监测时间包括鼻饲前1h和餐后3h.结果 肺炎组GER发生率为60.0％(15/25),对照组GER发生率为20.0％(2/10),两组比较差异有统计学意义(x2 =4.58,P＜0.05).肺炎组GER 84.5％出现于咳嗽/吸痰和腹部压力增加时.肺炎组与对照组各项反流指标比较差异均有统计学意义(P均＜0.05).重症肺炎患儿中伴GER者高血糖、腹胀、脓毒症、使用糖皮质激素的发生率明显高于不伴GER者(P均＜0.05).结论 重症肺炎儿童GER发病率高,表现为酸反流次数增加,酸清除能力降低.GER发生与疾病的严重程度相关.     

小儿胃食管返流

近年,学者对小儿胃食管反流(GER)综合征的研究极为重视。大多数学者认为,返流的主要原因是食管下端括约肌(LES)功能不全。GER早期表现是顽固性呕吐,在出生后即可开始,多数类似幽门痉挛。晚期并发营养不良、肺炎、贫血、食管狭窄等,威胁患儿生命。     

新生儿胃食管反流发病机理的研究

为探讨新生儿胃食管反流（ＧＥＲ）的发病机理，对３８例经钡餐造影诊为ＧＥＲ的患儿进行食管ｐＨ值动态监测和食管动力功能检查，１５例无症状儿作对照组。结果：ＧＥＲ组各项反流指标均显著大于对照组。３８例中１８例为生理性ＧＥＲ，２０例为病理性ＧＥＲ。病理性反流组下食管括约肌压力（ＬＥＳＰ）和屏障压（ＢＰ）均显著低于对照组，而食管功能的其他指标则差异无显著意义。以总ｐＨ值＜４百分时间２．７７％和综合评分８．９２为９５％参考值上限，则ＧＥＲ组病理性反流的检出率为５５．３％（２１／３８），高于对照组的６．７％（１／１５）（Ｐ＜０．０１）。ＬＥＳＰ和ＢＰ的９５％参考值下限分别为８．３９ｋＰａ、８．１５ｋＰａ，对照组无一例ＬＥＳＰ低下，ＧＥＲ组ＬＥＳＰ降低占１５．７％（６／３８），二组差异无显著意义（Ｐ＞０．０５）。提示：新生儿期食管功能已成熟，新生儿ＧＥＲ的发生不单是ＬＥＳＰ降低这一因素，还可能与短暂下食管括约肌松驰有关。     

Pathophysiology of gastroesophageal reflux and distal esophageal motility in children with gastroesophageal reflux disease

We investigated the mechanisms of gastroesophageal reflux (GER) and esophageal motility during endogenous esophageal acid exposure in 17 patients with reflux disease alone (age range 3-20 months) (group A) and in 10 patients with reflux disease complicated by esophagitis (age range 4-19 months) (group B), by simultaneous recording distal esophageal sphincter relaxation was the predominant mechanism of reflux in both groups of subjects; however, it was more frequent in group B patients (Bpts), whereas reflux episodes due to appropriate sphincter relaxation were detected more frequently in group A patients (Apts). During endogenous acid exposure, primary peristalsis was the most frequent esophageal motor event in all patients; furthermore, its amplitude was significantly higher in Apts as compared with Bpts. Primary peristalsis was more efficacious (rise of intraluminal pH by at least 0.5 unit) in patients with reflux disease alone, whereas nonspecific motor irregularities were more common in children with reflux esophagitis. It is concluded that the major mechanism of GER in patients with reflux esophagitis is an inappropriate sphincter relaxation; reflux due to appropriate sphincter relaxation is associated with less severe reflux disease; and patients with esophagitis exhibit a deranged esophageal motility during spontaneous acid exposure.     

Nonspecific esophageal motility disorders in children without gastroesophageal reflux.

BACKGROUND: Nonspecific esophageal motility disorders (NEMDs) have been identified in up to 50% of adults with noncardiac chest pain or dysphagia. This study sought to determine the incidence of NEMDs in children with upper gastrointestinal tract symptoms and to evaluate the clinical course of pediatric patients with these manometric abnormalities. METHODS: The study involved 154 children aged 4 to 18 years (mean age, 11.6+/-2.6 years [SE]) who had upper gastrointestinal, swallowing-related symptoms. The children were evaluated by 24-hour intraesophageal pH monitoring, esophageal manometry, and esophagogastroduodenoscopy. RESULTS: Gastroesophageal reflux (GER) was diagnosed by pH study in 109 (71%) of 154 patients, and examination of biopsy specimens demonstrated esophagitis in 70 children with GER. Results of esophageal manometry were abnormal in 30 (67%) of 45 children without GER. A variety of motility disorders were diagnosed in 17 of the patients without GER, whereas NEMDs were diagnosed in the remaining 13 children (mean age, 10.6+/-2.7 years; 10 boys, 3 girls). Patients with GER showed normal esophageal wave propagation; however, mean lower esophageal sphincter pressure was significantly lower in patients with GER than in children with NEMDs. The children with NEMDs exhibited a diverse array of symptoms, including esophageal food impaction in 4 of the 13 patients. During a 36.2+/-4.3-month follow-up period, no correlation was found between therapeutic intervention and clinical course in the 13 patients with NEMDs. Symptomatic improvement occurred in 6 of 13 patients, including 3 children for whom no pharmacologic therapy was prescribed. CONCLUSIONS: These data indicate that NEMDs represent a common group of esophageal manometric abnormalities in children with upper gastrointestinal tract symptoms and without GER. Food impaction appears to be a relatively frequent complication, and NEMDs should be considered in children who have this finding.     

先天性膈疝术后食管功能及胃食管反流的临床观察

目的 了解先天性膈疝修补术后预后及术后食管功能和胃食管反流情况。方法 对46例先天性膈疝修补术后进行随访，13例进行了24h食管双极pH及24h动态压力测定，了解胃食管功能。结果 13例进行了24h食管pH及压力测定的膈疝修补术后患儿中，7例有胃食管反流，其中3例术中应用补片，4例术前显示胃疝入胸腔。结论 先天性膈疝修补术后可出现胃食管反流，24h测压及pH测定表现为食管蠕动功能明显减弱，这种食管下端蠕动功能减弱与膈疝修补术后出现胃食管连接解剖异常及膈肌发育不良可能相关。     

Esophageal motility and gastroesophageal reflux in children with chronic respiratory diseases

Children with chronic respiratory diseases may be a high-risk population for gastroesophageal reflux (GER). In order to describe GER in this population, we systematically studied 7-h pH-metry and prolonged esophageal manometry (over 45 min) in 124 children admitted for respiratory disorders without digestive symptoms. The results showed that: (1) GER varied in significance before and after meals; (2) postprandial reflux was correlated with esophageal motor activity, but preprandial reflux was not; (3) moderate refluxers had reduced lower esophageal sphincter (LES) pressure, but severe refluxers had no significative decrease in LES pressure. The use of multivariate analysis permitted us to conclude that long-term esophageal manometry and pH-metry were complementary in defining severe GER. Offprint requests to: M. Bouchoucha     

Esophageal aperistalsis following fundoplication in a patient with trisomy 21

Gastrointestinal abnormalities are frequent in patients with Down syndrome (DS), gastroesophageal reflux (GER) being prominent among them. A 10-year-old boy with DS presented with progressive daily vomiting and an upper gastrointestinal study documenting reflux. A laparoscopic Nissen fundoplication was performed uneventfully. Postoperative inability to take solids was noted and a contrast study showed a tight gastroesophageal junction and poor peristalsis. Persistent symptoms were not alleviated by esophageal dilatation, despite a relaxing lower esophageal sphincter. Esophageal manometry documented complete esophageal aperistalsis. A percutaneous endoscopic gastrostomy was placed and the patient required long-term tube feeds. Esophageal aperistalsis is a rare condition in DS, likely superimposed on GER. Fundoplication may adversely affect the already abnormal esophageal motility in these children. Esophageal manometry preoperatively will identify motility disorders and assist in selecting the best management for these patients. Accepted: 26 May 1998     

Late follow-up in patients with gastroschisis

During a 16-year period, 60 neonates with gastroschisis were treated at the Department of Pediatric Surgery in Graz; 6 died and 54 (90%) survived. A questionnaire was sent to 45 patients, who were called for a medical examination; 31 patients (69%) came to follow-up, 26 of whom reported minor abdominal problems that could be related to gastroesophageal reflux (GER). Fifteen agreed to 24-h esophageal pH monitoring and/or upper gastrointestinal series; in 7 pathological GER could be demonstrated. Manometric studies in 6 patients revealed a motility disorder of the esophagus. Only 4 children were concerned by a disfiguring scar or the absence of a navel. Heigtt and weight were within normal limits and the children had developed normally.     

Segmental response of the lower esophageal sphincter to increased intragastric pressure

An important controversy exists concerning the adaptive capacity of the lower esophageal sphincter (LES) in response to increases in intragastric pressure. This capacity would characterize the LES as a dynamic element in preventing gastroesophageal reflux (GER). This physiological property was studied in 15 male cats using an experimental model in which the gastroesophageal antireflux barrier was generated eyclusively by the intrinsic tone of the LES. Under these conditions, the intragastric pressure (GP) and sphincter pressure (LESP) were measured by electromanometric procedures. When the gastric lumen was perfused with known volumes (25, 50, 75, 100, 125, 150 ml) of saline solution, increases in GP and LESP were observed. Both pressures increased slowly as the gastric volume rose, and when both values were equal, GER appeared. Studying the physiological properties of the LES by direct methods in this model, we conclude that (a) there is segmental pressure response of the LES when faced with direct opening stimulation such as an increase in GP; and (b) the increase in LES resting tone has a linear relation with the increase in GP.     

Esophageal pH monitoring for detecting gastroesophageal reflux in children with repaired esophageal atresia

Gastroesophageal reflux (GER) is a common problem in children who were operated upon for esophageal atresia. Reflux can cause serious complications in these children; therefore, it would be of value to identify patients at risk at an early stage. From October 1987 to January 1989, 12 infants with esophageal atresia were operated upon at St Göran's Department of Pediatric Surgery and then followed with ph monitoring at the ages of 1,3,6, and 12 months. At 1 month of age, 5 children had a reflux index of 5% or more; 4 of these 5 developed symptoms of GER. None of the children who had a reflux index of less than 5% showed any symptoms of reflux.It is concluded that pH monitoring at the age of approximately 1 month in children who have been operated upon for esophageal atresia may identify patients belonging to a risk group, who need closer follow-up for symptoms of reflux. Offprint requests to: M. Montgomery