Asemptomatik ve ösefajitli çocuklarda ösefagusun 24 saatlik pH monitörizasyonu

24-hour esophageal pH monitoring in asymptomatic children and in patients with oesophagitis

Özet

Gastroösefageal reflu (GÖR), sağlıklı çocuklarda görülen fizyolojik bir olay olmakla birlikte, sıklığında ve süresinde artış ile patolojik bir durum haline gelmektedir. Bu tabloda normal ve patolojik değerler arasında büyük bir "grey zone" vardır. Bu çalışmada asemptomatik ve ösefajitli çocukların 24 saatlik ösefagus pH monitorizasyon verileri karşılaştırılarak "overlapping" durumu araştırıldı. Çalışma grubu 38 asemptomatik (yaş dağılımı 0-16 yaş, ortalama 6.6 yıl) ve 26 Geboes histolojik kriterlerine göre ösefajit tanısı alan (yaş dağılımı 1-17 yaş, ortalama 9.9 yıl) toplam 64 çocuktan oluşmaktadır. Asemptomatik grupta ortalama reflü indeksi (Rl) 3.61 ± 0.44, 24 saatlik total reflü sayısı 81.32 ±10.17, beş dakikadan uzun reflü sayısı 1.66 ± 0.33, en uzun reflü süresi (dk) 7.21 ± 0.98, pH

Abstract

Gastroesophageal reflux (GÖR) is a "physiologic event" occurring in nearly all healthy children, but is considered abnormal if it occurs too frequently. However, what distingushes normal and abnormal reflux in GOR disease of childhood is not clearly defined. The aim of this study was to investigaate this "grey-zone" using the data of 24-hour esophageal pH monitoring of asymptomatic children and patients with esophagitis. The present study included in 64 children. Of the 64 children studied, 38 were asymptomatic (range 0-16 years, mean 6.6) and 26 patients (range 1-17 years, mean 9.9) had esophagitis according to thi histologie criteria of Geboes. In the asymptomatic group, reflux index (Rl) was 3.61 ± 0.44, the number of reflux episodes was 81.32 ± 10.17, number of reflux episodes longer than five minutes 1.66 ± 0.33, longest reflux episode (min) 7.21 ± 0.98, and area under pH curve (pH'min) 42.92 ±5.58. In the esophagitis group, Rl was 14.60 ± 11.40, the number of reflux episodes was 213.0 ± 255.0, number of reflux episodes longer than five minutes 5.48 ± 5.80, longest reflux episode (min) 46.80 ± 48.01, and area under pH curve (pH*min) 259.0 ± 314.0. According to logistic regression, the most reliable parameter was the Rl. The area under pH curve was not considered as a valuable criterion. The Rl and number of reflux episodes longer than five minutes were considered the most valuable criteria in the esophagitis group. It should be noted that the Rl and patient's age alone are sufficient for classifying the rate of GOR in childhood as normal or abnormal, with a high percentage of accuracy (93.4%).