ABSTRACT
Abstract Introduction Current practice guidelines in gastroesophageal reflux disease (GERD) often require invasive diagnostic testing. Objective The aim of the present study was to evaluate the significance of extra-esophageal symptoms and reliability of a screening risk score that is simple to use. Methods A longitudinal retrospective single-institution cohort study. Setting: A university clinical hospital tertiary referral center. The present study enrolled pediatric patients with symptoms suggestive of GERD: epigastric pain, occasional nausea, regurgitation, tasting acid in the oral cavity, chronic cough, hoarseness of voice, frequent throat clearing. The patients underwent 24-hour esophageal pH monitoring and fiber-optic laryngoscopy. The correlations between the local findings, anamnestic and objective measurement data were analyzed. Results The present study evaluated 89 pediatric patients. Patients with asthma presented significantly more often with adjoining gastrointestinal symptoms (p = 0.0472). Patients that were obese were linked to a higher rate of reports of gastrointestinal symptoms (p = 0.0495). After the patients had been assigned to newly developed risk groups, obesity showed to be significantly more frequent in patients placed in higher risk groups (p < 0.0001) for a positive GERD diagnosis. Conclusion Patients with leading symptoms of asthma presented significantly more often with adjoining gastrointestinal symptoms. Obesity showed to be significantly more frequent in patients placed in higher risk groups for a positive GERD diagnosis.
ABSTRACT
Abstract Gastroesophageal Reflux Disease (GERD) with high prevalence and incidence in the pediatric population is a relevant issue in public health. The literature associates family psychosocial aspects with chronic childhood illness. The present study examined the psychological alterations and peculiarities of caregivers and of children with GERD (n = 26) and healthy children (n = 30) from 3 to 12 years of age. Instruments: Sociodemographic Questionnaire and Assessment of Risk Factors for Child Illness; Hospital Anxiety and Depression Scale; and Rutter's Child Behavior Scale (A2), all of which were administered to the caregivers. Quantitative data analysis (χ2 test, Fisher's exact test and ANOVA) was performed, respecting each instrument's respective criteria. In the group of children with GERD, we observed both a higher incidence of alcohol and/or drug use/abuse and higher levels of anxiety and depression on the part of the caregivers, as well as psychosocial problems involving the child. In light of the developmental level expected for this age group, greater frequency of behavioral problems was also observed. We thus conclude that there is a correlation between family psychological traits and GERD in children, stressing the need for conducting further studies and for supervising interdisciplinary clinical practices in the health care of this population.
Resumo A Doença do Refluxo Gastroesofágico (DRGE) com alta prevalência e incidência na população pediátrica é tema relevante em saúde pública. A literatura associa aspectos psicossociais familiares e adoecimento crônico infantil. Esta pesquisa investigou alterações psicológicas e rastreou especificidades de cuidadores e crianças, de 3 a 12 anos, com DRGE (n=26) e hígidas (n=30). Instrumentos: Questionário Sociodemográfico e Avaliação de Fatores de Risco para Adoecimento da Criança, Escala Hospitalar de Ansiedade e Depressão, e Escala de Comportamento Infantil A2 (Rutter); todos aplicados aos cuidadores. Realizou-se análise quantitativa dos dados (Teste χ2, Teste Exato de Fisher e ANOVA), respeitando os critérios de cada instrumento. Observou-se maior incidência tanto do uso/abuso de álcool/droga, quanto do nível elevado de ansiedade e depressão do cuidador, além de problemas psicossociais, envolvendo a criança, no grupo de crianças com DRGE. Notou-se, também, maior frequência de problemas comportamentais, considerando o desenvolvimento esperado para a idade. Este estudo concluiu existir, na criança, associação entre aspectos psicológicos familiares e a DRGE, ressaltando a necessidade de aprofundar estudos e direcionar a prática clínica interdisciplinar na assistência à saúde desta população.
Resumen La enfermedad del reflujo gastroesofágico (ERGE) con alta prevalencia e incidencia en la población pediátrica es tema relevante en salud pública. La literatura asocia aspectos psicosociales familiares y enfermedad crónica infantil. Este estudio investigó alteraciones psicológicas y rastreó especificidades de cuidadores y niños, de 3 a 12 años, con ERGE (n = 26) e hígidas (n = 30). Instrumentos: Cuestionario Sociodemográfico y Evaluación de Factores de Riesgo para la Enfermedad del Niño, Escala Hospitalaria de Ansiedad y Depresión, y Escala de Comportamiento Infantil A2 (Rutter); todos aplicados a los cuidadores. Se realizó un análisis cuantitativo de los datos (Prueba χ2, Test Exacto de Fisher y ANOVA), respetando los criterios de cada instrumento. Se observó mayor incidencia tanto del uso / abuso de alcohol / droga, como del alto nivel de ansiedad y depresión del cuidador, y problemas psicosociales involucrando al niño, en el grupo de niños con ERGE. Así como, se notó mayor frecuencia de problemas conductuales, considerando el desarrollo esperado para la edad. Este estudio concluyó que existe asociación entre aspectos psicológicos familiares y la ERGE en el niño, resaltando la necesidad de profundizar estudios y dirigir la práctica clínica interdisciplinaria en la asistencia a la salud de esta población.
ABSTRACT
Introducción: La enfermedad por reflujo gastroesofágico (ERGE) tiene una alta morbi-mortalidad. El estándar de oro es la pHmetría de 24 horas (pH24h). Objetivo: Determinar la asociación entre síntomas y los parámetros de la pH24h. Métodos: Es un estudio descriptivo, retrospectivo y comparativo en 35 niños menores de 14 años con ERGE que consultaron al Hospital Universitario del Valle ®Evaristo García¼ de Cali, Colombia, a quienes se les tomaron datos como nombre, edad, género, síntomas y talla. Se dividieron en tres grupos según la presentación clínica: síntomas digestivos (grupo 1), respiratorios (grupo 2) y mixtos (grupo 3). Se definió desnutrición crónica cuando el déficit de la talla para la edad era > 5% según las tablas de la NCHS. Los parámetros a la pH24h analizados fueron el índice de reflujo (IR), el número de episodios ácidos, el número de episodios ácidos >5 min, la duración del episodio más prolongado y su asociación con síntomas. El análisis estadístico se hizo con la prueba t de Student, siendo significativo una p<0.05. Resultados: Se incluyeron 35 niños (47.9±41.3 meses), 20 varones, 2 con síntomas digestivos, 17 con síntomas respiratorios, y 16 mixtos, con un déficit de la talla para la edad de 8.0±10.89%. En 20 (57.1%) la pH24h fue anormal según los parámetros de Vandenplas: 12 en el grupo 1, 1 en el grupo 2 y 7 en el grupo 3. Los parámetros a la pH24h fueron: IR 5.25±4.94%; número de episodios ácidos 77.21±78.96; número de episodios ácidos >5 min 1.30±3.67 y la duración del episodio más prolongado 9.36±20.06 min; sin diferencias significativas al ser comparados los 3 grupos (p>0.05), teniendo los niños del grupo respiratorio los parámetros más comprometidos: IR 4.75±5.17%, número de episodios ácidos 79.17±79.76, número de episodios ácidos >5 min 2.29±4.97 y duración del episodio más prolongado 15.0±27.04 min; así como su estado nutricional (p=0.003).
Introduction: Pediatric gastroesophageal reflux disease (GERD), has a high morbidity-mortality. The gold standard is the 24 hours pHmetry (pH24h). The objective is to determine the relationship between symptoms and parameters of pH24h. Methods: This is a comparative, descriptive, and retrospective study. N=35 children <14 years old suffering GERD, from the HUV in Cali, Colombia. Data: age, gender, symptoms and stature were taken. Children were divided into three groups: digestive (group 1), respiratory (group 2) and mixed (group 3). They were classified as chronic undernourished (deficit height/age >5%) according to tables from the NCHS. From pH24h were taken: reflux index (RI), number of acid episodes, number of episodes >5 min and duration of the longest episode and association with symptoms. The statistical analysis was the Students test t, having p<0.05 as significant. Results: 35 children were included (47.9±41.3 months), 20 males, 2 with digestive symptoms, 17 with respiratory and 16 with both symptoms, with a deficit of H/A= 8.0±10.89%. 20 (57.1%) pH24h were abnormal by Vandenplas criterion: 12 in group 1, 1 in group 2 and 7 in group 3. The parameters of pH24h were: IR 5.25±4.94%; number of acid episodes 77.21±78.96; number of acid episodes >5 min 1.30±3.67 and the duration of the longest episode 9.36±20.06 min. There were no significant differences between the parameters of pH24h and the study groups (p>0.05). The respiratory group showed pH24h parameters more involved: IR 4.75±5.17%, number of acid episodes 79.17±79.76, number of acid episodes >5 min 2.29±4.97 and duration of the longest episode 15.0±27.04 min; the same as their nutritional status (p=0.003).