Effect of prokinetics in children with recurrent nocturnal retrosternal pain.

BACKGROUND: Children rarely present with vague complaints of nocturnal recurrent retrosternal or upper-abdominal, epigastric, pain. Dysmotility of the upper gastrointestinal tract, including gastro-oesophageal reflux, might be at the origin of these manifestations. OBJECTIVE: To evaluate the clinical effect of prokinetics (cisapride) in children with recurrent nocturnal retrosternal pain, and to measure the effect of cisapride with a combined oesophageal ambulatory 24 h pH and pressure monitoring. PATIENTS: Twelve children, mean age 9.5 years (range 4.1-14.0 years), with nocturnal recurrent retrosternal pain for more than 6 months, occurring at least three times a week. METHODS: Single-blinded prospective study, with two periods of 2-3 weeks during which cisapride was administered, alternated with two placebo periods of the same duration. Clinical evaluation, and assessment with oesophageal pH and pressure monitoring. RESULTS: Cisapride was related to a temporary relief of the symptoms in 10/12 children. The improvement was demonstrated through a normalization of pH monitoring, and an increase in amplitude and duration of the contractions in the lower oesophagus. CONCLUSION: Cisapride improves complaints of recurrent nocturnal retrosternal pain in children.

The contribution of specific immunoglobulin M antibodies to the diagnosis of Helicobacter pylori infection in children.

OBJECTIVE: To evaluate the diagnostic value of specific immunoglobulins G and M in the detection of Helicobacter pylori infection. METHODS: Sera from 68 H. pylori-infected children and 35 H. pylori-negative children (aged 1-15 years) were examined using recent-generation serum enzyme-linked immunosorbent assay (ELISA) tests (Malakit Helicobacter pylori series; Biolab, Limal, Belgium). RESULTS: All of the investigated children had positive values for immunoglobulin G antibodies. However, anti-H. pylori-specific immunoglobulin M could be detected only in 19 (27.9%) of the 68 children. When compared with the 13C-urea breath test, these findings represent sensitivity, specificity and positive and negative predictive values of 27.9, 100, 100 and 41.7%, respectively, for the serum ELISA test for the detection of H. pylori-specific immunoglobulin M compared with 100.0, 97.2, 98.5 and 100.0%, respectively, for the Malakit for the detection of specific immunoglobulin G antibodies. CONCLUSION: Although H. pylori-specific immunoglobulin G has been established as a reliable indicator of active H. pylori infection, using the Malakit for the detection of H. pylori-specific immunoglobulin M does not seem to be of major value in the diagnosis of H. pylori infection in children.

The role of "occult" gastroesophageal reflux in chronic pulmonary disease in children.

It has repeatedly been demonstrated that a correlation exists between gastroesophageal reflux and the presence of various "atypical" complaints, such as recurrent chest pain, apneic attacks in infants, and recurrent or chronic respiratory symptoms. Very recently it has been shown that gastroesophageal reflux is frequently associated with non-controlled asthma in children and that medical treatment for reflux can improve the further course of respiratory disease. The aim of the present study was to investigate a possible cause-relationship between recurrent respiratory symptoms in children and the presence of gastroesophageal reflux disease, and to investigate the value of continuous 24-hour esophageal pH-monitoring in the diagnosis and management of these complaints in 62 children with chronic respiratory disease. Continuous 24-hour pH-monitoring was abnormal in 39/62 patients (62.9%). However, no statistically significant correlation could be detected between the presence of gastroesophageal reflux and various anamnestic parameters (parental smoking, pet in household, sibling with gastroesophageal reflux disease), or concomitant atopy. All children that were found positive for gastroesophageal reflux (n = 39) were started on an antireflux therapy (cisapride 0.2 mg/kg q.i.d.). This treatment resulted in an improvement of the symptoms in 84.6%. We conclude that gastroesophageal reflux is an important (causative) factor in chronic recurrent respiratory disease. This entity is often resistant to "classical" respiratory treatment, but can be treated with an anti-reflux therapy. We, therefore, suggest to perform continuous 24-hour esophageal pH-monitorings as a standard procedure in all patients with recurrent respiratory complaints, independent of the severity of their symptoms.