Comparación entre pH-metría convencional e impedanciometría intraluminal multicanal en niños con patología respiratoria / Comparison between conventional ph measurement and multichannel intraluminal esophageal impedance in children with respiratory disorders

Introducción: El RGE se asocia a sintomatología respiratoria; se ha demostrado la relación entre el RGE no ácido y su etiopatogenia. La impedancia intraluminal multicanal esofágica (MII) es capaz de detectar RGE no ácido y alcalino, así como la altura de ascenso del reflujo. Objetivo: Comparar la eficacia en el diagnóstico de reflujo gastroesofágico ácido y no ácido de la pH-metría bicanal y la MII en pacientes con patología respiratorio. Pacientes y métodos: Estudio longitudinal, prospectivo de pacientes con diagnóstico de asma persistente al tratamiento, tos crónica o laringitis de repetición. Se realizó monitorización continua durante 24 h mediante MII-pH-metría doble canal y análisis descriptivo de los datos comparando ambas técnicas entre sí. Se realizó un análisis descriptivo y comparativo mediante la prueba de la t de Student y el test de MacNemar como prueba no paramétrica. Resultados: Entre septiembre 2008 y abril 2010 se incluyó a 49 pacientes con patología respiratoria (79,6% asma crónica, 10,2% tos crónica y 10,2% laringitis). La media de reflujos detectados por pH-metría fue de 18,3 (rango 0-93) y por MII de 39,2 (11-119) (p<0,001). El índice sintomático fue 6,7% por pH-metría y 13,9% por MII (p<0,05). El número de niños diagnosticados de RGE ácido por pH-metría fue de 7 y mediante MII se diagnosticaron 25 niños (8 ácidos, 10 alcalinos y 7 mixtos). La media de reflujos proximales detectados por MII fue de 21. Conclusiones: La MII es capaz de diagnosticar mayor número de reflujos tanto ácidos como alcalinos que la pH-metría convencional en los niños con patología respiratoria resistente al tratamiento, así como detectar reflujos proximales(AU)

Introduction: Gastroesophageal reflux (GER) is associated with respiratory symptoms. The link between non-acid GER and the pathogenesis of respiratory disease has been demonstrated. Esophageal multichannel intraluminal impedance (MII) is able to detect non-acid and alkaline GER, as well as reflux height. The objective of the study was to compare the diagnostic effectiveness of dual-channel pH-meter and MII. Patients and methods: A prospective study was conducted on patients diagnosed with uncontrolled asthma, persistent cough, or chronic laryngitis. Patients were monitored continuously for 24hours using a combination of MII and a dual-channel pH-meter. A descriptive and comparative analysis of the techniques was performed using the t test for comparison between groups and McNemar test for non-parametric data. Results: A total of 49 patients with respiratory disease between September 2008 and April 2010 (79.6% uncontrolled asthma, 10.2% persistent cough, and 10.2% chronic laryngitis) were included in the study. The mean number of refluxes detected was 18.3 (range 0-93) using the pH-meter and 39.2 (11-119) using MII (P<.001). Acid GER was detected using pH in 7 children and using MII in 25 children (8 acid, 10 alkaline and 7 mixed). A mean of 21 proximal refluxes were detected using MII. Conclusions: MII makes it possible to diagnose a greater number of refluxes, whether acid or alkaline, than conventional pH measurement in children with respiratory disease that is poorly controlled with their usual treatment. MII can also detect proximal refluxes(AU)

[Comparison between conventional ph measurement and multichannel intraluminal esophageal impedance in children with respiratory disorders]. / Comparación entre pH-metría convencional e impedanciometría intraluminal multicanal en niños con patología respiratoria.

INTRODUCTION: Gastroesophageal reflux (GER) is associated with respiratory symptoms. The link between non-acid GER and the pathogenesis of respiratory disease has been demonstrated. Esophageal multichannel intraluminal impedance (MII) is able to detect non-acid and alkaline GER, as well as reflux height. The objective of the study was to compare the diagnostic effectiveness of dual-channel pH-meter and MII. PATIENTS AND METHODS: A prospective study was conducted on patients diagnosed with uncontrolled asthma, persistent cough, or chronic laryngitis. Patients were monitored continuously for 24 hours using a combination of MII and a dual-channel pH-meter. A descriptive and comparative analysis of the techniques was performed using the t test for comparison between groups and McNemar test for non-parametric data. RESULTS: A total of 49 patients with respiratory disease between September 2008 and April 2010 (79.6% uncontrolled asthma, 10.2% persistent cough, and 10.2% chronic laryngitis) were included in the study. The mean number of refluxes detected was 18.3 (range 0-93) using the pH-meter and 39.2 (11-119) using MII (P<.001). Acid GER was detected using pH in 7 children and using MII in 25 children (8 acid, 10 alkaline and 7 mixed). A mean of 21 proximal refluxes were detected using MII. CONCLUSIONS: MII makes it possible to diagnose a greater number of refluxes, whether acid or alkaline, than conventional pH measurement in children with respiratory disease that is poorly controlled with their usual treatment. MII can also detect proximal refluxes.

Esofagitis eosinofílica / Eosinophilic esophagitis

La esofagitis eosinofflica es una enfermedad caracterizada por una infiltración anormal de eosinófilos en el esófago distal. Los síntomas, la mayoría de las veces, son indistinguibles de los del reflujo gastroesofágico, e incluyen vómitos, regurgitaciones, náuseas, dolor epigástrico y disfagia, con escasa respuesta a la medicación antirreflujo. Se presenta el caso de dos niñas con síntomas digestivos compatibles con reflujo gastroesofágico, sin antecedentes alérgicos de interés, con mala respuesta al tratamiento médico antirreflujo, que fueron diagnosticadas mediante esofagos gastroscopia y biopsia esofágica de esofagitis esosinofflica. Las pruebas alérgicas fueron positivas a determinados alimentos. Evolucionaron de forma adecuada con una dieta exenta de alérgenos

Eosinophilic esophagitis is a disease characterized by eosinophilic infiltration of the esophageal mucosa. The symptoms, in the majority of the cases, are indistinguishable from gastroesophageal reflux disease, and include vomiting, regurgitation, nausea, epigastric pain and dysphagia, but the patients rarely respond to antireflux therapy. We report the cases of two girls who presented gastrointestinal symptoms compatible with gastroesophageal reflux disease. They had no notable history of allergic reactions, but responded poorly to antireflux medication. Esophagogastroscoapny desophageabliops yrevealed the presence of eosinophilice sophagitis.The girls were found to be allergic to certain foods and showed a satisfactory improvement when these foods were eliminated from their diets