Lucas Dalle Molle

Nocturnal reflux in children and adolescents with persistent asthma and gastroesophageal reflux.

Background. A higher frequency of nocturnal gastroesophageal reflux (GER) in adult patients with respiratory symptoms has been demonstrated. The aim of this study was to determine the prevalence of nocturnal GER by using prolonged intraesophageal pH monitoring and compare it with spirometry results in children with persistent asthma. Methods. Thirty-eight patients with persistent asthma for at least 2 years were studied. Gastrointestinal symptoms suggestive of GER were considered as regurgitation, heartburn, and abdominal pain. All patients underwent prolonged intraesophageal pH study and spirometry. GER was considered positive when a reflux index (RI) was higher than 5%. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced mid-expiratory flow rate (FEF25 − 75%), and FEV1/FVC ratio were measured. Results. Median age was 10 years of age (range 5 to 15) and 58% were male; GER prevalence was 47.3%. Median (range) of reflux index during supine and upright periods from GER patients were, respectively, 8.7% (3.2 to 23.6) and 10.5% (5.2 to 15.0) (p = 0.913), and only FEF25 − 75% was below the predicted value: 54.5% (39.4 to 96.9). Reflux index was not significantly correlated with FVC, FEV1 and FEF25 − 75%. Conclusions. A high prevalence of GER was found in children and adolescents with persistent asthma, equally distributed in the supine (nocturnal) and upright positions. There was no correlation with pulmonary function test.

Predomínio de manifestações respiratórias na indicação de pHmetria esofágica prolongada em crianças

BACKGROUND: An increasing prevalence of extraesophageal complications of gastroesophageal reflux (GER) has been seen. Evaluation of clinical profiles of patients submitted to prolonged esophageal pH monitoring could help to identify the patients who could benefit from the early diagnosis of GER. OBJECTIVE: To evaluate the population, indications and results of esophageal pH-monitoring for the diagnosis of GER in a pediatric gastroenterology clinic. PATIENTS AND METHODS: Data from 190 children and adolescents who had esophageal pH-monitoring were analyzed. A descriptive analysis of the population was performed and the children were categorized in five groups according to the age. The equipment used was a Digitrapper MKIII (Synetics) and all data were analyzed by using a software EsopHogram 5.7. Reflux index was established for analysis. RESULTS: The most frequent indications for the exam were: asthma (26,8%), apnea/cianosis (20%), recurrent pulmonary infections (18,4%), wheezing infant syndrome (15,8%) and chronic cough/horseness (11%). The most frequent groups of age for the respiratory symptoms were: asthma - above 5 years (92,2%); apnea/cianosis - under 3 months (55,3%); recurrent pulmonary infections and wheezing infant syndrome - 3 to 12 months (31,4% and 83,3%). Reflux index of patients with positive exam for GER was significantly higher in patients under 2 years than above 2 years of age. CONCLUSION: Respiratory symptoms were predominant among the indications for esophageal pH-monitoring in children. The knowledge of the clinical profile of the patients who had esophageal pH monitoring could help to improve the technical quality of the exam.