Fatores de risco para a doença por refluxo gastroesofágico em recém-nascidos de muito baixo peso portadores de displasia broncopulmonar / Risk factors for gastroesophageal reflux disease in very low birth weight infants with bronchopulmonary dysplasia

OBJETIVO: Conhecer os fatores de risco para a doença por refluxo gastroesofágico (DRGE) em recém-nascidos de muito baixo peso com displasia broncopulmonar. MÉTODOS: Realizou-se um estudo caso-controle incluindo 23 casos e 23 controles com displasia broncopulmonar, sendo realizada investigação por monitorização prolongada do pH esofágico no período de janeiro de 2001 a outubro de 2005. Para cada caso, selecionou-se um controle, e foram comparados pela idade gestacional, peso ao nascimento, gênero, uso de corticóide pré-natal, tempo de ventilação assistida, tempo de oxigenoterapia, tempo de uso de sonda gástrica, uso de xantinas, idade pós-conceptual e peso durante a monitorização do pH esofágico. Realizou-se a análise por regressão logística múltipla para estabelecer o odds ratio (OR) com intervalo de confiança de 95 por cento (IC95 por cento). RESULTADOS: Os dois grupos (com e sem DRGE) não apresentaram diferenças significativas em relação às variáveis demográficas e de evolução pós-natal, uso de corticóide pré e pós-natal, bem como ao tempo de uso de cafeína, ventilação mecânica e oxigenoterapia. Entretanto, as variáveis intolerância alimentar (OR = 6,55; IC95 por cento 1,05-40,8) e tempo de uso de sonda gástrica (OR = 1,67; IC95 por cento 1,11-2,51) comportaram-se como fatores de risco para DRGE. A variável idade pós-conceptual ao exame de monitorização do pH (OR = 0,02; IC95 por cento < 0,001-0,38) comportou-se como fator protetor para DRGE. CONCLUSÃO: Os dados obtidos permitem inferir que o tempo prolongado de uso de sonda gástrica e a intolerância alimentar aumentam a probabilidade para DRGE. Já a maior idade pós-conceptual ao exame diminui a chance para DRGE em prematuros com menos de 1.500 g com displasia broncopulmonar.

OBJECTIVE: To assess risk factors for gastroesophageal reflux disease (GERD) in very low birth weight infants with bronchopulmonary dysplasia. METHODS: A case-control study was carried out in 23 cases and 23 control subjects with bronchopulmonary dysplasia submitted to 24-hour esophageal pH monitoring between January 2001 and October 2005. Cases and controls were compared for gestational age, birth weight, gender, use of antenatal steroids, duration of assisted ventilation, duration of oxygen therapy, length of gastric tube use, administration of xanthines, postconceptual age, and weight at esophageal pH monitoring. Multiple logistic regression analysis was used to establish the odds ratio(OR) with a 95 percent confidence interval (95 percentCI). RESULTS: None of the groups (with and without GERD) showed statistically significant differences in terms of demographic variables and postnatal outcome, use of antenatal and postnatal corticosteroids, or in terms of caffeine use and duration of mechanical ventilation and oxygen therapy. However, feeding intolerance (OR = 6.55; 95 percentCI 1.05-40.8) and length of gastric tube use (OR = 1.67; 95 percentCI 1.11-2.51) turned out to be risk factors for GERD. Postconceptual age at the time of pH monitoring (OR = 0.02; 95 percentCI < 0.001-0.38) was regarded as a protective factor against GERD. CONCLUSION: The data obtained allow inferring that prolonged gastric tube use and feeding intolerance increase the risk for GERD. On the other hand, older postconceptual age at the time of pH monitoring reduces the risk for GERD in preterm infants with bronchopulmonary dysplasia weighing less than 1,500 g.

Analysis of the effect of omeprazole and tegaserod on non-erosive reflux disease / 中国实用内科杂志

0.05).Conclusion Omeprazole and Tegaserod improved the reflux symptoms of the NERD patients.Omeprazole improves abnormal acid exposure but not abnormal bile exposure.Tegaserod improved neither abnormal acid exposure nor abnormal bile exposure.

Gastroesophageal Reflux in Mechanically Ventilated Preterm Infants / 대한소아소화기영양학회지

PURPOSE: Besides interferencence of esophageal motor function by the nasogastric tube, a decline of the positive gastro-esophageal pressure gradient caused by intermittent positive pressure ventilation seems to have a major role in the pathogenesis of gastroesophageal reflux (GER) in mechanically ventilated preterm infants. The aim of this study was to determine the incidence of GER and associated risk factors in mechanically ventilated preterm infants. METHODS: Twenty four hour esophageal pH monitorings were performed using a antimony electrode on 11 mechanically ventilated preterm infants in Neonatal Intensive Care Unit in Pusan National University Hospital. We evaluated the following reflux parameters; reflux index, reflux episodes/ hour, reflux episodes > or =5 min/hour, duration of longest episode, and percent episodes > or =5 min. Patients were considered to have significant GER if more than 2 among 5 parameters were satisfied. RESULTS: The mean gestational age of the patients was 30.9 weeks, mean birth weight was 1,568 g, and mean age at the time of pH monitoring was 2.8 days. Significant GER was detected in 4 patients (36.4%). There was no relationship between the incidence of GER and gestational age, birth weight, postnatal age, or the ventilator settings. CONCLUSION: The incidence of GER in mechanically ventilated preterm infants was similar, compared with other previous studies. Associated risk factors of GER in these patients were not detected. Therefore, mechanical ventilation in preterm infants does not seem to be the high risk factor of GER.

24 Hour Esophageal PH Monitoring in Preterm Infants / 대한소아소화기영양학회지

PURPOSE: Gastroesophageal reflux (GER) has been found to be the causative factors of apnea, stridor, feeding intolerance, poor weight gain, and sudden infants death syndrome (SIDS) in infants. GER is a well-described in infants and children, but only scant mention of the premature infants with GER can be found in the literature. METHODS: Esophageal pH was measured during 24 hour in 21 healthy preterm infants, using a silicone microelectrode with an external reference electrode connected to a portable recorder. The mean age of the patients was 29+/-8 days, mean gestational age was 30(+5)+/-2(+0) weeks, mean birth weight was 1,468+/-329 g, mean postconceptional age was 34(+6)+/-1(+4) weeks and mean weight was 1,750+/-329 g. We evaluated the following reflux parameters; number of acid reflux, number of long acid reflux, longest acid reflux minutes, and reflux index. RESULTS: Pathologic GER was detected in 12 (57%) subjects and most interesting parameters are reflux index and number of episodes with a pH<4 during 24 hour (high correlation with postprandial reflux index). Reflux was not correlated to gestational age, birth weight, age, postconceptional age, weight, sex and medication of the theophylline. CONCLUSION: Gastroesophageal reflux is common in preterm infants, but it is usually not apparent, even with severe reflux.

Gastroesophageal Reflux Disease in Children with Chronic Cough

PURPOSE: We investigated the incidence of gastroesophageal reflux disease (GERD) by 24-hour esophageal pH monitoring in patients who had chronic cough for more than 3 weeks. METHODS: From January 1995 to August 1996, 33 patients with chronic cough which had lasted for more than 3 weeks were enrolled in the 24-hour esophageal pH monitoring. The result was interpreted with the standard value which was suggested by Yvan Vandenplas in 1991 for patients younger than 15 months and with the De Meester Score for patients older than 15 months. We performed esophagoscopy and lower esophageal biopsy for patients who proved to have gastroesophageal reflux disease by 24-hour esophageal pH monitoring. RESULTS: Among 33 cases, 13 cases (39.4%) were proved to have GERD. Comparing between the normal group and the GERD group, there was no difference of gastroesophageal reflux incidence according to meal or position. We performed esophagoscopy in 10 patients among 13 GERD cases. There were 3 cases of gross esophagitis. Papillary height was elongated by more than 50% of normal in 7 cases, and basal cell layer increased by more than 20% of normal in 6 cases. Neutrophil or eosinophil infiltration was found in 2 cases, and lymphocyte infiltration was found in 7 cases. CONCLUSION: We suggest that 24-hour esophageal pH monitoring and appropriate treatment should be considered in prolonged unexplained chronic cough.

A Case of Gastroesophageal Reflux Disease Who Shows Asthma Symptoms / 소아알레르기및호흡기학회지

Gastroesophageal reflux(GER) is a common clinical problem, classically manifested by regurgitation or nonprojectile vomiting. Other respiratory manifestations such as chronic cough, asthma, and recurrent pneumonia are being increasingly recognized; the so-called "atypical" or "extraesophageal" manifestations. The relationship between GER and pulmonary complications has been recognized since the 1960s. The association of GER and pulmonary disease is further supported by reports showing the relief of respiratory symptoms and improvement in results of pulmonary function tests after medical or surgical antireflux treatment in asthmatics. Two different mechanisms for GER-associated pulmonary diseases have been postulated :(1) microaspiration of gastric contents into the lung resulting in an inflammatory reaction, the "reflux theory," and (2) activation by GER of a vagal reflex are from the esophagus to the lung resluting in bronchoconstriction, the "reflex theory." Many diagnostic tests have been proposed to evaluate the presence of GER disease. 24-hour-esophageal pH monitoring has been 113ported to have a higher sensitivity and specificity than any other single c1mical test-It is considered as the go1d standard method. We experienced a case of infantile asthma due m GER diagnosed by 24-hour esophageal pH monitoring in seven-month-old infant who presented wheezing and dyspnea. She was much improved clinically and at follow-up pH monitoring for respiratory symptoms and refulx with medical antireflux therapy(cisapride).