Diagnosis of gastroesophageal reflux and anti-reflux procedures among Polish children with gastrostomies: a 10-year nationwide analysis.

BACKGROUND/OBJECTIVES: To analyse the approach to diagnose gastroesophageal reflux (GER) and the qualification criteria for anti-reflux (AR) procedures in Polish children fed via gastrostomy between 2000 and 2010. SUBJECTS/METHODS: An electronic questionnaire containing questions on the demographic and clinical data of patients with gastrostomies was distributed to six Polish centres of nutritional therapy. The portion pertaining to GER included data on clinical exponents, diagnostic procedures (pH-metry, pH-impedance, scintigraphy and upper gastrointestinal (GI) series) and AR. RESULTS: In total, 348 children (M199/F149; age at gastrostomy 5.78±5.49 years) were included. Data on the diagnosis of GER and the AR criteria were available for 343 and 336 subjects, respectively. Percutaneous endoscopic gastrostomy was performed in 258/348 patients (74.1%), while surgery was performed in 80/348 patients (23%). The data from 10/348 (2.9%) cases were unavailable. At least one of the tests for GER was conducted in 177/343 (51.6%) of patients: pH-metry in 74/343 (21.6%), pH-impedance in 17/343 (5.0%), scintigraphy in 60/343 (17.5%) and upper GI series in 102/343 (29.7%). GER was reported in 114/343 cases (33.2%), and fundoplication was performed in 87 children (76.3% of patients with GER). The highest congruence between a positive test result and the decision to perform fundoplication was documented in cases of scintigraphy and upper GI series (P=0.00000 and P=0.00191, respectively). A significant increase in the prevalence of simultaneous gastrostomy and AR was observed over the decade analysed (r=0.8, P=0.009). This study revealed a centre-specific attitude towards the diagnosis of GER and the assessment of qualifications for fundoplication in Polish gastrostomy-fed children. CONCLUSIONS: The unified diagnostic algorithm of GER and the universal qualification criteria for AR procedures need to be defined for gastrostomy-fed children.

[Morphological picture of alimentary tract in the process of food allergy in children]. / Obraz morfologiczny przewodu pokarmowego w przebiegu alergii pokarmowej u dzieci.

Morphological and histopathological changes in the mucosa of the stomach, duodenum and small and large intestine have been evaluated in 83 children aged between 12 months and 15 years with diagnosed food allergy. The examined patients were analysed depending on clinical symptoms. Among 23 children aged 7-15 years, in whose clinical picture abdomen pains dominated, endoscopic examination of upper part of alimentary tract was performed. In 22 children (66.6%) macroscopic changes in stomach mucosa were observed. Histopathological examination of excisions from optically changed places showed variations in 13 children (39.3%). In 43 children aged 12 months--8 years with dominating symptoms of protracted diarrhoea and/or body mass deficiency, biopsy of small intestine mucosa was examined. In 13 children (30.2%) subtotal villus atrophy was observed, in 14 children (32.5%)--partial and in 16 children (37.3%) no small intestine mucosa atrophy was noticed. In all patients lymphocytic infiltrations occurred in small intestine mucosa lamina propria. Large intestine inflammation was observed in food allergy process in 7 children. In the cases of food allergy in children the inflammation changes in mucosa can be seen in all of its sections. Over 2/3 of examined children with food allergy showed inflammation and inflammation-atrophical changes in alimentary tract mucosa.