ZNAČAJ RAZLIČITIH METODA ZA DETEKCIJU GASTROEZOFAGEALNOG REFLUKSA KOD DECE
Sažetak
Dijagnoza gastroezofagealne refluksne bolesti (GERB) zasnovana na simptomima nije specifična zbog visoke prevalencije poremećaja koji mogu da oponašaju GERB. Konvencionalni pH monitoring, kombinovani pH-MII (“multichannel intraluminal impedance”) i endoskopija su najčešće korišćene dijagnostičke metode kod dece.
Kombinovani pH-MII monitoring je najtačniji dijagnostički metod za detekciju GERB-a kod dece, sa tendencijom da postane zlatni standard. Kod novorođenčadi i verovatno kod dece sa ekstraezofagealnim simptomima MII daje najveći doprinos validnosti pH-MII monitoringa. Visoka prevalencija funkcionalne gorušice kod dece starije od 8 godina ukazuje na značaj pH-MII monitoringa i u ovoj starosnoj grupi. Većina studija pokazala je dobne razlike u hemijskom sastavu refluksata. Slabokiseli refluks je češći kod odojčadi i često je povezan sa simptomima, dok je kiseli refluks češći kod starije dece i adolescenata. Senzitivnost endoskopije je veoma niska u poređenju sa pH-MII monitoringom kao referentnim testom. Endoskopija je dijagnostička metoda izbora za potvrdu refluksnog ezofagitisa, ali se pH-MII parametri mogu smatrati potencijalnim markerima za procenu integriteta sluznice jednjaka.
Najznačajniji nedostatak pH-MII monitoringa je nedostatak normativnih podataka za decu, zbog toga je standardizacija obavezna. Za sada pH-MII monitoring ima ograničen uticaj na lečenje GERB-a, pre svega zbog nedostatka efikasne terapije za slabokiseli refluks, što ukazuje da dalja istraživanje treba usmeriti u ovom smeru.Reference
Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009 Oct;49(4):498–547.
Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, Kato S, Koletzko S, et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol. 2009 May;104(5):1278–1295; quiz 1296.
Frazzoni M, De Micheli E, Savarino V. Different patterns of oesophageal acid exposure distinguish complicated reflux disease from either erosive reflux oesophagitis or non-erosive reflux disease. Aliment Pharmacol Ther. 2003 Dec 1;18(11–12):1091–8.
Gupta SK, Hassall E, Chiu Y-L, Amer F, Heyman MB. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci. 2006 May;51(5):858–63.
Pilic D, Fröhlich T, Nöh F, Pappas A, Schmidt-Choudhury A, Köhler H, et al. Detection of gastroesophageal reflux in children using combined multichannel intraluminal impedance and pH measurement: data from the German Pediatric Impedance Group. J Pediatr. 2011 Apr;158(4):650–654.e1.
Loots CM. Gastroesophageal reflux in children: the use of pH-impedance measurements and new insights in treatment [Internet]. 2011 [cited 2017 Apr 24]. Available from: http://dare.uva.nl/search?arno.record.id=400659
Orenstein SR. Symptoms and reflux in infants: Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R)--utility for symptom tracking and diagnosis. Curr Gastroenterol Rep. 2010 Dec;12(6):431–6.
Salvatore S, Vandenplas Y. Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics. 2002 Nov;110(5):972–84.
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul;128(1):3-20.e6; quiz 21-22.
Hassall E. Over-prescription of acid-suppressing medications in infants: how it came about, why it’s wrong, and what to do about it. J Pediatr. 2012 Feb;160(2):193–8.
Wenzl TG, Benninga MA, Loots CM, Salvatore S, Vandenplas Y, ESPGHAN EURO-PIG Working Group. Indications, methodology, and interpretation of combined esophageal impedance-pH monitoring in children: ESPGHAN EURO-PIG standard protocol. J Pediatr Gastroenterol Nutr. 2012 Aug;55(2):230–4.
Shin MS. Esophageal pH and Combined Impedance-pH Monitoring in Children. Pediatr Gastroenterol Hepatol Nutr. 2014 Mar;17(1):13–22.
Shay S, Richter J. Direct comparison of impedance, manometry, and pH Probe in detecting reflux before and after a meal. Dig Dis Sci. 2005 Sep;50(9):1584–90.
Hojsak I, Ivković L, Trbojević T, Pavić I, Jadrešin O, Mišak Z, et al. The role of combined 24-h multichannel intraluminal impedance-pH monitoring in the evaluation of children with gastrointestinal symptoms suggesting gastro-esophageal reflux disease. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2016 Oct;28(10):1488–93.
Salvatore S, Arrigo S, Luini C, Vandenplas Y. Esophageal impedance in children: symptom-based results. J Pediatr. 2010 Dec;157(6):949-954.e1-2.
Lüthold SC, Rochat MK, Bähler P. Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation. World J Gastroenterol. 2010 May 21;16(19):2401–6.
Loots CM, Benninga MA, Davidson GP, Omari TI. Addition of pH-impedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux. J Pediatr. 2009 Feb;154(2):248–52.
Nazer D, Thomas R, Tolia V. Ethnicity and gender related differences in extended intraesophageal pH monitoring parameters in infants: a retrospective study. BMC Pediatr. 2005 Jul 18;5:24.
Mousa HM, Rosen R, Woodley FW, Orsi M, Armas D, Faure C, et al. Esophageal Impedance Monitoring for Gastroesophageal Reflux. J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):129–39.
Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32 Suppl 2:S1-31.
Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991 Oct;88(4):834–40.
Boix-Ochoa J, Lafuenta JM, Gil-Vernet JM. Twenty-four hour exophageal pH monitoring in gastroesophageal reflux. J Pediatr Surg. 1980 Feb;15(1):74–8.
Lupu VV, Ignat A, Paduraru G, Ciubara A, Moscalu M, Marginean CO, et al. Correlation between the different pH-metry scores in gastroesophageal reflux disease in children. Medicine (Baltimore). 2016 Jun;95(26):e3804.
Stanford EA, Chambers CT, Craig KD. The role of developmental factors in predicting young children’s use of a self-report scale for pain. Pain. 2006 Jan;120(1–2):16–23.
Ristic N, Milovanovic I, Radusinovic M, Stevic M, Ristic M, Ristic M, et al. The comparative analyses of different diagnostic approaches in detection of gastroesophageal reflux disease in children. PloS One. 2017;12(11):e0187081.
Salvatore S, Hauser B, Vandemaele K, Novario R, Vandenplas Y. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr. 2005 Feb;40(2):210–5.
Aggarwal S, Mittal SK, Kalra KK, Rajeshwari K, Gondal R. Infant gastroesophageal reflux disease score: reproducibility and validity in a developing country. Trop Gastroenterol Off J Dig Dis Found. 2004 Jun;25(2):96–8.
Orenstein SR, Shalaby TM, Cohn JF. Reflux symptoms in 100 normal infants: diagnostic validity of the infant gastroesophageal reflux questionnaire. Clin Pediatr (Phila). 1996 Dec;35(12):607–14.
Deal L, Gold BD, Gremse DA, Winter HS, Peters SB, Fraga PD, et al. Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. J Pediatr Gastroenterol Nutr. 2005 Aug;41(2):178–85.
Kleinman L, Rothman M, Strauss R, Orenstein SR, Nelson S, Vandenplas Y, et al. The Infant Gastroesophageal Reflux Questionnaire Revised: Development and Validation as an Evaluative Instrument. Clin Gastroenterol Hepatol. 2006 May 1;4(5):588–96.
Thilmany C, Beck-Ripp J, Griese M. Acid and non-acid gastro-esophageal refluxes in children with chronic pulmonary diseases. Respir Med. 2007 May;101(5):969–76.
Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O’Connor JA. Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedance-pH monitoring. J Pediatr. 2006 Aug;149(2):216–9.
Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol. 2004 Dec;99(12):2452–8.
Cinquetti M, Micelli S, Voltolina C, Zoppi G. The pattern of gastroesophageal reflux in asthmatic children. J Asthma Off J Assoc Care Asthma. 2002 Apr;39(2):135–42.
Al-Asoom LI, Al-Rubaish A, Al-Quorain AA, Qutub H, El-Munshid HA. The association of gastroesophageal reflux with bronchial asthma. Can asthma also trigger reflux? Hepatogastroenterology. 2006 Feb;53(67):64–72.
Liu Y-W, Wu J-F, Chen H-L, Hsu H-Y, Chang M-H, Hsu W-C, et al. The Correlation between Endoscopic Reflux Esophagitis and Combined Multichannel Intraluminal Impedance-pH Monitoring in Children. Pediatr Neonatol. 2016 Oct;57(5):385–9.
Richter JE. Diagnostic tests for gastroesophageal reflux disease. Am J Med Sci. 2003 Nov;326(5):300–8.
An evidence-based appraisal of reflux disease management--the Genval Workshop Report. Gut. 1999 Apr;44 Suppl 2:S1-16.
Francavilla R, Magistà AM, Bucci N, Villirillo A, Boscarelli G, Mappa L, et al. Comparison of esophageal pH and multichannel intraluminal impedance testing in pediatric patients with suspected gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2010 Feb;50(2):154–60.
Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O’Connor JA. Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement. J Pediatr Gastroenterol Nutr. 2006 Jan;42(1):16–21.
Sifrim D, Dupont L, Blondeau K, Zhang X, Tack J, Janssens J. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut. 2005 Apr;54(4):449–54.
Shay S, Tutuian R, Sifrim D, Vela M, Wise J, Balaji N, et al. Twenty-four hour ambulatory simultaneous impedance and pH monitoring: a multicenter report of normal values from 60 healthy volunteers. Am J Gastroenterol. 2004 Jun;99(6):1037–43.
Zerbib F, des Varannes SB, Roman S, Pouderoux P, Artigue F, Chaput U, et al. Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects. Aliment Pharmacol Ther. 2005 Nov 15;22(10):1011–21.
Skopnik H, Silny J, Heiber O, Schulz J, Rau G, Heimann G. Gastroesophageal reflux in infants: evaluation of a new intraluminal impedance technique. J Pediatr Gastroenterol Nutr. 1996 Dec;23(5):591–8.
Wenzl TG, Moroder C, Trachterna M, Thomson M, Silny J, Heimann G, et al. Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 2002 May;34(5):519–23.
Mousa H, Woodley FW, Metheney M, Hayes J. Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr. 2005 Aug;41(2):169–77.
Zhong C, Duan L, Wang K, Xu Z, Ge Y, Yang C, et al. Esophageal intraluminal baseline impedance is associated with severity of acid reflux and epithelial structural abnormalities in patients with gastroesophageal reflux disease. J Gastroenterol. 2013 May;48(5):601–10.
Pilic D, Hankel S, Koerner-Rettberg C, Hamelmann E, Schmidt-Choudhury A. The role of baseline impedance as a marker of mucosal integrity in children with gastro esophageal reflux disease. Scand J Gastroenterol. 2013 Jul;48(7):785–93.
Salvatore S, Hauser B, Devreker T, Arrigo S, Marino P, Citro C, et al. Esophageal impedance and esophagitis in children: any correlation? J Pediatr Gastroenterol Nutr. 2009 Nov;49(5):566–70.
Savarino E, Tutuian R, Zentilin P, Dulbecco P, Pohl D, Marabotto E, et al. Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy. Am J Gastroenterol. 2010 May;105(5):1053–61.
Conchillo JM, Schwartz MP, Selimah M, Samsom M, Sifrim D, Smout AJ. Acid and non-acid reflux patterns in patients with erosive esophagitis and non-erosive reflux disease (NERD): a study using intraluminal impedance monitoring. Dig Dis Sci. 2008 Jun;53(6):1506–12.
Bredenoord AJ, Hemmink GJM, Smout AJPM. Relationship between gastro-oesophageal reflux pattern and severity of mucosal damage. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2009 Aug;21(8):807–12.
Cho YK, Lee JS, Lee TH, Hong SJ, Park SJ, Jeon SR, et al. The Relationship of the Post-reflux Swallow-induced Peristaltic Wave Index and Esophageal Baseline Impedance with Gastroesophageal Reflux Disease Symptoms. J Neurogastroenterol Motil. 2017 Apr;23(2):237–44.
Farré R, Blondeau K, Clement D, Vicario M, Cardozo L, Vieth M, et al. Evaluation of oesophageal mucosa integrity by the intraluminal impedance technique. Gut. 2011 Jul;60(7):885–92.
Waśko-Czopnik D, Błoński W, Paradowski L. Diagnostic difficulties during combined multichannel intraluminal impedance and pH monitoring in patients with esophagitis or Barrett’s esophagus. Adv Med Sci. 2007;52:196–8.
Salvatore S, Salvatoni A, Van Steen K, Ummarino D, Hauser B, Vandenplas Y. Behind the (impedance) baseline in children. Dis Esophagus Off J Int Soc Dis Esophagus. 2014 Dec;27(8):726–31.
van der Pol RJ, Loots CM, Peeters L, Vandenplas Y, Hauser B, Devreker T, et al. Outcomes of endoscopy and novel pH-impedance parameters in children: is there a correlation? J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):196–200.
Cohen Sabban J, Bertoldi GD, Ussher F, Christiansen S, Lifschitz C, Orsi M. Low-impedance Baseline Values Predict Severe Esophagitis. J Pediatr Gastroenterol Nutr. 2017 Sep;65(3):278–80.
Frazzoni M, Manta R, Mirante VG, Conigliaro R, Frazzoni L, Melotti G. Esophageal chemical clearance is impaired in gastro-esophageal reflux disease--a 24-h impedance-pH monitoring assessment. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2013 May;25(5):399–406, e295.
Frazzoni L, Frazzoni M, de Bortoli N, Tolone S, Furnari M, Martinucci I, et al. Postreflux swallow-induced peristaltic wave index and nocturnal baseline impedance can link PPI-responsive heartburn to reflux better than acid exposure time. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2017 Nov;29(11).
Bashashati M, Hejazi RA, Andrews CN, Storr MA. Gastroesophageal reflux symptoms not responding to proton pump inhibitor: GERD, NERD, NARD, esophageal hypersensitivity or dyspepsia? Can J Gastroenterol Hepatol. 2014 Jun;28(6):335–41.
Kahrilas PJ, Keefer L, Pandolfino JE. Patients with refractory reflux symptoms: What do they have and how should they be managed? Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2015 Sep;27(9):1195–201.
de Bortoli N, Ottonello A, Zerbib F, Sifrim D, Gyawali CP, Savarino E. Between GERD and NERD: the relevance of weakly acidic reflux. Ann N Y Acad Sci. 2016 Sep;1380(1):218–29.