小儿反复呼吸道感染与胃食管返流关系的探讨

目的　探讨小儿反复呼吸道感染（ＲＲＩ）与胃食管返流（ＧＥＲ） 的关系。方法　采用便携式ｐＨ 自动记录仪对３５ 例反复呼吸道感染患儿进行２４ 小时食管ｐＨ 值监测,以３０ 例健康儿为对照组。结果　ＲＲＩ组ｐＨ 值＜ ４的检出次数、返流持续时间≥５ 分钟的检出次数、最长返流持续时间、总ｐＨ＜４ 的时间占总监测时间的百分率、Ｂｏｉｘ－ Ｏｃｈｏａ 综合评分均显著大于对照组（ Ｐ＜ ０－０１） ,ＲＲＩ组胃食管返流发生率为５７－１ ％ （２０／３５）,显著高于对照组（１／３０）。结论　ＲＲＩ患儿胃食管返流的发生率高,两者之间有密切关系。     

24小时食管pH值监测在小儿支气管哮喘诊治中的应用

目的探讨胃食管返流（ＧＥＲ）与小儿支气管哮喘的关系，了解２４小时食管ｐＨ值监测在小儿哮喘诊治中的作用。方法用便携式２４小时ｐＨ自动记录仪，监测３８例支气管哮喘患儿食管下端ｐＨ值变化，３０例无症状儿为对照组，对１５例合并病理性ＧＥＲ患儿进行抗返流治疗，复查８例。结果哮喘组８项返流指标均显著大于对照组（Ｐ＜０．０１），其病理性ＧＥＲ的检出率为３９％（１５／３８），显著高于对照组（１／３０）（Ｐ＜０．０１）；小儿哮喘合并病理性ＧＥＲ者其返流以卧位和夜间时严重；经雷尼替丁抗返流治疗后，各项返流指标除了立位ｐＨ＜４时间百分比外，均显著下降（Ｐ＜０．０１或＜０．０５），近期随访结果显示，哮喘得到有效控制。结论ＧＥＲ是诱发小儿哮喘发作的一个重要因素，哮喘合并病理性ＧＥＲ的患儿对制酸药物抗返流治疗有良好的反应，２４小时食管ｐＨ值监测在小儿哮喘的病因诊断和疗效观察上有重要的应用价值。     

窒息后新生儿胃食管测压及双pH监测的研究

目的探讨出生窒息对新生儿胃肠运动功能的影响。方法用多导生理记录仪测定了３５例窒息后新生儿和１７名对照新生儿的食管和胃内压力，并用晶体锑双ｐＨ微电极和便携式２４小时ｐＨ记录仪，对受试者进行了２４小时胃食管双ｐＨ动态监测。结果两组食管及胃内测压差异不显著；双ｐＨ动态监测发现，窒息组反映酸性胃食管返流的各项参数均明显高于对照组，其中酸性返流指数窒息组／对照组为７．１／１．３；返流次数为１３７．４／２８．５；返流＞５分钟的次数５．９／０．７；ｐＨ＜４总时间１５７．０／２０．１；食管廓清时间１．０／０．４，差异均有非常显著意义（Ｐ＜０．０１）。结论窒息后新生儿酸性胃食管返流较对照组明显增加，各项参数已超过病理性胃食管返流诊断标准     

幽门螺杆菌相关性胃炎患儿的食管胃pH值监测及部分胃肠激素研究

目的探讨幽门螺杆菌（Ｈｐ）相关性胃炎患儿的胃肠动力变化特点。方法应用放射免疫分析和食管胃ｐＨ监测技术对５８例Ｈｐ阳性和４７例Ｈｐ阴性慢性胃炎患儿的血清胃泌素、血浆胃动素、十二指肠胃食管返流等进行了对比研究。结果Ｈｐ阳性组血清胃泌素水平高于Ｈｐ阴性组和正常对照组（ｔ值分别为３．３２６、３．８３７，Ｐ均＜０．０１）；Ｈｐ阳性组血浆胃动素水平低于Ｈｐ阴性组和正常对照组（ｔ值分别为２．５９４、４．４３２，Ｐ＜０．０５和０．０１）。Ｈｐ阳性组胃食管返流发生率为２１％，低于Ｈｐ阴性组中的４８％（χ２＝３．８１２，Ｐ＞０．０５）；Ｈｐ阳性组十二指肠胃返流发生率为５０％，高于Ｈｐ阴性组中的１３％（χ２＝７．３８３，Ｐ＜０．０１）。结论Ｈｐ感染可以导致慢性胃炎患儿血中胃泌素水平升高和血中胃动素水平降低；Ｈｐ相关性胃炎患儿胃食管返流的发生有减少的可能，十二指肠胃返流的发生显著增多     

胃源性哮喘患儿雷尼替丁治疗及随访观察

目的探讨胃源性哮喘患儿经雷尼替丁治疗的随访结果。方法对５２例经便携式２４小时ｐＨ自动记录仪确诊的胃食管返流（ＧＥＲ）阳性哮喘患儿加用雷尼替丁治疗３个月,临床随访２年;１７例治疗后第２次复查食道ｐＨ值。结果雷尼替丁治疗的有效率９３６％（４４／４７）,治疗后酸性返流指数、最长返流时间、Ｂｏｉｘ－Ｏｃｈｏａ综合评分低于治疗前,Ｐ＜００５,而ｐＨ＜４的返流次数及返流≥５分钟的次数与治疗前无显著差异（Ｐ＞００５）。结论ＧＥＲ是诱发小儿哮喘的原因之一,ＧＥＲ阳性时胃酸分泌增多,雷尼替丁是治疗胃源性哮喘的有效药物。     

动态24小时食管pH值监测小儿胃食管返流

为了解２４小时食管ｐＨ值监测在小儿胃食管返流（ＧＥＲ）诊治中的作用，研究小儿病理性ＧＥＲ的特点及其诊断标准，对５０例经钡餐造影诊为ＧＥＲ的患儿进行动态２４小时食管内ｐＨ值监测，３０例健康小儿为对照组，复查１３例病理性ＧＥＲ患儿治疗后（９例为手术治疗）的食管ｐＨ值。结果表明，ＧＥＲ组各项返流指标显著高于对照组。对照组中１例为病理性ＧＥＲ，ＧＥＲ组３１例为病理性，另１９例则为生理性。１３例食管裂孔疝（ＨＨ）患儿均有明显的病理性返流，其各项返流指标除ｐＨ值＜４次数外均显著高于单纯病理性ＧＥＲ；ＨＨ组卧位时返流≥５分钟次数、最长返流时间、总ｐＨ值＜４的时间占总观察时间的百分比和平均返流周期均显著大于立位时；单纯病理性ＧＥＲ组卧位时返流≥５分钟次数、最长返流时间和平均返流周期显著大于立位时，而返流次数则小于立位时。提示小儿病理性ＧＥＲ以卧位时明显，伴有食管裂孔疝者返流更为严重。动态２４小时食管内ｐＨ值监测可用于小儿ＧＥＲ的诊断、分析和疗效评定。     

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。     

胃食管双pH监测小儿十二指肠胃食管返流

采用胃、食管双ｐＨ电极对２１例１～１２个月小儿进行２４ｈｐＨ值监测。７例无返流小儿为对照组，１４例有返流的小儿中９例为酸性返流（６４％），５例（３６％）为碱性返流即十二指肠胃食管返流（其中４例合并酸性返流）。碱性返流可引起严重的食管病变。传统的单一食管下端ｐＨ监测难以作出准确诊断，增加胃底ｐＨ监测为准确判定返流，特别是十二指肠胃食管返流提供重要根据，对于提高胃食管返流诊断率和指导临床对不同类型的返流进行有效治疗具有重要意义。     

小儿胃食管返流与肺炎：附126例分析

通过对１２６例小儿胃食管返流伴肺炎及同收治的１５０例单纯肺炎的主要临床表现，全并症，疗程及疗效等方面进行对照分析，发现小儿胃食管食管返流伴肺炎组中胸片证实为吸入性肺炎５６例（４４．４％），存在围产期窒息史及屏气发作明显高于单纯性肺炎组（Ｐ＜０．０１），疗程明显长于单纯性肺炎组（Ｐ＜０．０１），单纯性肺炎组织疗有效率（９２．７％）明显高于胃食管返流伴肺炎组（７７．０％），两组比较有显著性差异。     

窒息后新生儿食管测压及双PH监测的研究

目的 探讨出生窒息对新生儿胃肠运动功能的影响。方法 用多导生理记录仪测定了３５例窒息后新生儿和１７名对照新生儿的食管和胃内压力，并用晶体锑双ＰＨ微电极和便携式２４小时ＰＨ记录仪，对受试者进行了２４小时胃食管双ＰＨ动态监测。结果 两组食管及胃内测压差异不显著：双ＰＨ动态监测发现，窒息组反映酸性胃食管返流的各项参数均明显高于对照组，其中酸性返流指数窒息组／对照组为７．１／１．３；返流次数为１３７．４／     

Prevalence and treatment of silent gastro-oesophageal reflux in children with recurrent respiratory disorders

Thirty-six infants and children presenting with recurrent respiratory disorders (RRD) as the sole clinical symptom including bronchial asthma (6), recurrent obstructive bronchitis with or without wheezing (18), chronic nocturnal cough (3), recurrent episodes of pneumonia (3), recurrent pharyngitis (3) and recurrent laryngitis (3) were investigated for associated gastro-oesophageal reflux (GER) by oesophagram, endoscopy and continuous 24 h pH monitoring of the distal oesophagus.The pH monitoring criteria were selected on the basis of a preliminary study comparing statistically measurements of 32 variables recorded in 15 patients who all had clinical, radiological and endoscopic evidence of GER and in 8 asymptomatic controls. Although patients with symptomatic GER differed significantly from the asymptomatic ones for 27 variables examined, 6 variables emerged as having the highest value for discrimination (overlap score 0–1). Among these, the Euler-Byrne index (number of reflux pH<4+4 times the number of reflux episodes of more than 5 min), the percentage of total reflux time and the number of reflux episodes 1 h post-cibal scored 0 (no overlap). GER was considered to be present when at least five of these six parameters were abnormal.The overeall incidence of GER in children with RRD was 41% (15) when detected by oesophagram and 61% (22) when diagnosed by pH monitoring criteria. In the children with bronchial asthma or with recurrent laryngitis, the percentage of reflux time during sleep was about 40 times higher than in asymptomatic controls and 2 times higher than in those with symptomatic GER. Of the 22 patients with RRD and GER, 9 were elected to have fundoplication because of poor response to medical antireflux management. All of these, showed complete (6) or partial (3) resolution of respiratory symptoms. Of the 13 patients in whom medical therapy was continued, 9 showed satisfactory improvement with a mean follow-up time of 1 year. Silent GER might be an important contributing factor to the severity of some common chronic respiratory disorders in children.Abbreviation RRD recurrent respiratory disorders - GER gastro-oesophageal reflux     

Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedance-pH monitoring

OBJECTIVES: To determine the proportion of acid and nonacid reflux events in children with asthma suspected to have gastroesophageal reflux (GER) using combined impedance-pH monitoring, and to determine the symptom index (SI) for nonacid and acid reflux events. STUDY DESIGN: This was a prospective study of children with asthma (age 5 months to 6 years) referred for evaluation of GER. Exclusion criteria were congenital anomalies, cerebral palsy, mental retardation, and cardiac disease. The children underwent a 20-hour multichannel intraluminal impedance (MII)-pH study. RESULTS: A total of 24 children (17 male; mean age, 33 months) were enrolled from March 2004 to February 2005. MII-pH detected 1184 reflux events, versus 419 reflux events by pH alone; 51% (605 events) were nonacid. The proportion of nonacid reflux events decreased with time elapsed from last meal (P < .0001 by Pearson's chi2 test). A total of 555 symptoms were recorded, including 331 cases of cough, 243 of which (73.4%) were not associated with a reflux event. The SI for MII-pH was significantly different than that for the pH probe (37% vs 0%; P = .008). CONCLUSIONS: Acid and nonacid reflux occurs with equal frequency in children with asthma. Most symptoms occur in the absence of a reflux event.     

Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children

The association of lipid-laden alveolar macrophages (LLAM) and gastroesophageal reflux (GER) was investigated prospectively in 115 patients in two groups. Group 1 included 74 children with chronic respiratory tract disorders and documented GER by prolonged esophageal pH monitoring, barium esophagram, and esophagoscopy; group 2 included 41 children with chronic respiratory tract disorders without GER. LLAM were present in 63 (85%) and eight (19%) children from groups 1 and 2, respectively (P less than 0.0001). Thus a strong association between the presence of LLAM and GER in children with chronic respiratory tract disorders was established. We suggest that LLAM from bronchial lavage may be a useful marker for tracheal aspiration in children with GER in whom chronic lung disease may subsequently develop.     

Role of surgical treatment of gastro-esophageal reflux in children with severe asthma]

The relationship between gastro-esophageal reflux (GER) and asthma, and the role of treatment of this disorder in severe asthma cases remain ill-defined. Using esophageal pH monitoring, pathological GER was demonstrated in 57 of 139 children with severe asthma. Among these 57 patients medical treatment of GER lessened the respiratory symptoms in 24 and was without effect in 33. In the latter group, asthma was improved in 29 with surgical treatment of the GER, the results being less satisfactory in those patients without GER digestive symptoms. Our results suggest that there is a place for treatment of GER in selected children with severe asthma. Esophageal pH monitoring appears useful to detect pathological GER and to determine which patients may benefit from surgical treatment.     

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。     

彩色多普勒超声对胃食管反流的筛检价值

目的　探讨彩色多普勒超声对胃食管反流 (GER)的筛检价值。方法　用彩色多普勒超声以肝左叶为透声窗 ,经剑突下扫查胃食管反流患儿、正常对照儿童各 55例。分别测量与观察腹段食管长度、GER现象及反流发生频率。结果　腹段食管清晰显示率 1 0 0 % ;正常对照组小儿腹段食管长度随年龄增加而增长 ;病例组与之比较显示腹段食管长度缩短。彩超检查GER的灵敏性为 98.1 8% ;特异性为 76 .36 %。结论　彩色多普勒超声可以清晰显示腹段食管 ;胃食管反流患儿腹段食管长度缩短 ;彩色多普勒超声可作为胃食管反流的筛检手段。     

Gastroesophageal reflux as cause of chronic respiratory symptoms

Objective : Gastroesophageal reflux (GER) is a relatively common disorder in infants and children. It maybe associated with severe complications. The coexistence of GER and a wide range of respiratory symptoms has been reported. The purpose of our study was to investigate the relationship between chronic respiratory symptoms and GERD as an underlying cause. To our knowledge, there is not a method known study for identifying this relationship and prevalence in our area.Methods : The study group consists of fifty-two (4 months-10 years) children who were referred to pediatric surgery ward for evaluation of GERD as a cause of chronic respiratory symptoms by 24 hours PH monitoring. Additionally, 10 patients with only one episode of pneumonia were evaluated as the control group. Chronic respiratory presentations include the following: chronic cough, recurrent pneumonia, asthma, and respiratory distress.Results : 24 hour esophageal PH monitoring revealed GER in 22 (42.2%) patients as a cause of their chronic respiratory symptoms, while (30 (57.7%) children did not show any evidence of GER. GER was detected in 11 of 24 (45.7%) patients with chronic cough. Thirty-three patients presented with recurrent pneumonia, 13(39.9%) of whom had GER. In 8 patients with asthma, GER was found in 4 cases. None of the 6 patients with respiratory distress had GERD.Conclusion : The possibility of GERD was significantly higher in study group (children with chronic respiratory symptoms) compared to control group (p-value<0.01). All patients with chronic cough, recurrent pneumonia and asthma should be aggressively investigated for the possibility of GER. Documenting abnormal gastroesophageal reflux helps direct appropriate therapy before occurrence of major complications.