Ricerca
Indicazioni alla pH-metria esofagea
ESOPHAGEAL PH MONITORING
Martina Fornaro1, Erica Dal Bon1, Francesca Bissolo2, Alessandro Bodini2, Enrico Valletta2
1Scuola di Specializzazione in Pediatria e 2Clinica Pediatrica, Università di Verona
Aprile 2009 - pagg. 243 -247
Abstract
Aims: We reviewed the procedures performed during the last 18 years at the Pediatric Department of the University of Verona (Italy) to investigate how the clinical use of esophageal pH monitoring (EpHM) to diagnose gastroesophageal reflux disease has changed in our practice.
Methods: Data of EpHM from January 1990 to December 2007 were reviewed and the year in which the procedure was done, age of patients, clinical indication to the procedure and EpHM outcome were recorded.
Results: Eight hundred and twenty-two procedures were performed in 775 children. Children < 1 year of age were 39.6%, but they decreased from 72% in 1990-92 to 27% in 2005-07 (p < 0.001). Indications to EpHM were gastrointestinal in 55%, respiratory in 40% and different in 5% of children. EpHM was more frequently abnormal (54%) in children with gastrointestinal than in those with respiratory symptoms (35%, p < 0.001). A significant increase in the indications to EpHM due to respiratory symptoms was observed between 1990-92 (25%) and 2005-07 (63%) (p < 0.001). A strong decrease in abnormal EpHM was observed between 1990-92 (63%) and 2005-07 (19%, p < 0.001) and this decrease was inversely related to the yearly percentage of respiratory indications.
Conclusions: Our data show that significant modifications in patients’ age and indication to EpHM have occurred in our institution during the last two decades and that respiratory symptoms are today the most frequent indication to EpHM.
Methods: Data of EpHM from January 1990 to December 2007 were reviewed and the year in which the procedure was done, age of patients, clinical indication to the procedure and EpHM outcome were recorded.
Results: Eight hundred and twenty-two procedures were performed in 775 children. Children < 1 year of age were 39.6%, but they decreased from 72% in 1990-92 to 27% in 2005-07 (p < 0.001). Indications to EpHM were gastrointestinal in 55%, respiratory in 40% and different in 5% of children. EpHM was more frequently abnormal (54%) in children with gastrointestinal than in those with respiratory symptoms (35%, p < 0.001). A significant increase in the indications to EpHM due to respiratory symptoms was observed between 1990-92 (25%) and 2005-07 (63%) (p < 0.001). A strong decrease in abnormal EpHM was observed between 1990-92 (63%) and 2005-07 (19%, p < 0.001) and this decrease was inversely related to the yearly percentage of respiratory indications.
Conclusions: Our data show that significant modifications in patients’ age and indication to EpHM have occurred in our institution during the last two decades and that respiratory symptoms are today the most frequent indication to EpHM.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Rudolph CD, Mazur LJ, Liptak GS, et al.;
North American Society for Pediatric Gastroenterology
and Nutrition. Guidelines for
evaluation and treatment of gastroesophageal
reflux in infants and children: recommendations
of the North American Society for Pediatric
Gastroenterology and Nutrition. J Pediatr
Gastroenterol Nutr 2001;32 Suppl 2:S1-31.
2. Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007;56:1654-64.
3. Gibson PG, Henry RL, Coughlan JL. Gastrooesophageal reflux treatment for asthma in adults and children. Cochrane Database Syst Rev 2003;2:CD001496.
4. Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 2006;4:CD004823.
5. Morton RE, Wheatley R, Minford J. Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability. Dev Med Child Neurol 1999;41:329-34.
6. Sullivan PB. Gastrointestinal disorders in children with neurodevelopmental disabilities. Dev Disabil Res Rev 2008;14:128-36.
7. Working Group of the ESPGAN. A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992;14:467- 71.
8. Sondheimer JM. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants. J Pediatr 1980;96:804-7.
9. Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics 1991;88:834-40.
10. Boix-Ochoa J, Lafuenta JM, Gil-Vernet JM. Twenty-four hour esophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg 1980;15:74-8.
11. Orenstein SR, Orenstein D. Gastroesophageal reflux and respiratory disease in children. J Pediatr 1988;112:847-58.
12. Tolia V. Gastroesophageal reflux and supraesophageal complications: really true or ballyhoo? J Pediatr Gastroenterol Nutr 2002; 34:269-73.
13. Gold BD. Asthma and gastroesophageal reflux disease in children: exploring the relationship. J Pediatr 2005;146(Suppl 3):S13-20.
14. Sontag SJ. Why do the published data fail to clarify the relationship between gastroesophageal reflux and asthma? Am J Med 2000; 108(Suppl 4a):159S-69S.
2. Havemann BD, Henderson CA, El-Serag HB. The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007;56:1654-64.
3. Gibson PG, Henry RL, Coughlan JL. Gastrooesophageal reflux treatment for asthma in adults and children. Cochrane Database Syst Rev 2003;2:CD001496.
4. Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 2006;4:CD004823.
5. Morton RE, Wheatley R, Minford J. Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability. Dev Med Child Neurol 1999;41:329-34.
6. Sullivan PB. Gastrointestinal disorders in children with neurodevelopmental disabilities. Dev Disabil Res Rev 2008;14:128-36.
7. Working Group of the ESPGAN. A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992;14:467- 71.
8. Sondheimer JM. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants. J Pediatr 1980;96:804-7.
9. Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics 1991;88:834-40.
10. Boix-Ochoa J, Lafuenta JM, Gil-Vernet JM. Twenty-four hour esophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg 1980;15:74-8.
11. Orenstein SR, Orenstein D. Gastroesophageal reflux and respiratory disease in children. J Pediatr 1988;112:847-58.
12. Tolia V. Gastroesophageal reflux and supraesophageal complications: really true or ballyhoo? J Pediatr Gastroenterol Nutr 2002; 34:269-73.
13. Gold BD. Asthma and gastroesophageal reflux disease in children: exploring the relationship. J Pediatr 2005;146(Suppl 3):S13-20.
14. Sontag SJ. Why do the published data fail to clarify the relationship between gastroesophageal reflux and asthma? Am J Med 2000; 108(Suppl 4a):159S-69S.
Corrispondenza: enrico.valletta@azosp.vr.it