Publication: Gastroözefageal Reflü Hastalarının Retrospektif İncelenmesi
Abstract
Bu çalışma Ondokuz Mayıs Üniversitesi Çocuk Gastroenteroloji Hepatoloji ve Beslenme Bilim Dalı'nda gastroözefageal reflü hastalığı tanısı ile izlenen çocukların yakınma, fizik muayene, görüntüleme bulgularının saptanması, uygulanan tedavi ile tedaviye yanıtlarının değerlendirilmesi amacıyla planlandı.Haziran 2007-Haziran 2011 yılları arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Gastroenteroloji Bilim Dalı polikliniğinde Gastroözefageal Reflü Hastalığı tanısıyla takip edilen 274 olgunun hastane kayıtları ve dosya verileri retrospektif olarak incelendi.Olguların 118'i (%43,1) kız, 156'sı (%56,9) erkek olup ortalama yaşları 4,9 ± 4,2 yıl(1-16,3 yıl) olarak saptandı. Yaş gruplarına göre değerlendirildiğinde olguların 67'si (%24,5) 1 yaş altında(Grup-1), 80'i (29,2) 1-3 yaş arası (Grup-2), 57'si (%20,8) 4-7 yaş arası (Grup-3), 47'si (%17,2) 8-11 yaş arasında (Grup-4), 23'ü (%8,4) ise 12-18 yaş arasında (Grup-5)idi.Hastaların sistemlere göre şikayetleri solunum ve gastrointestinal sistem belirtiları olarak ikiye ayrıldı. 98 hastanın gastrointestinal belirtilerle, 41 hastanın solunum sistemi belirtileriyle, 135 hastanın ise hem gastrointestinal hem de solunum sistemi belirtileriyle başvurduğu tesbit edildi. Gastrointestinal belirtiler arasında en sık belirti kusma, solunum sistemi belirtileri arasında ise en sık belirti öksürüktü. Belirtiler yaş grubuna göre göre değerlendirildiğinde hırıltı ve öksürük oranı en sık grup-1 ve grup-2' de, karın ağrısı, göğüs ağrısı, ağza acı su gelme ve göğüste yanma ise grup 3, grup-4, grup-5'te mevcuttu. 274 hastanın tanı yöntemleri incelendiğinde, 110 hastaya GÖR sintigrafisi, 58'ine 24 saat özefageal pH monitorizasyonu ile, 92'sine ise klinik olarak GÖRH tanısı konulduğu, 9 hastaya ÖMD ve 5'ine de üst gastrointestinal sistem endoskopisi uygulandığı görüldü.Çalışmamızın kapsadığı tarih aralığında GÖRH ön tanısı ile 131 hastaya 24 saat özefageal pH monitorizasyonu yapılmış, 58 hastada (%44,3) patolojik reflü saptanmıştı. pH monitorizasyonu yapılan hastaların 69'u erkek, 62'si kız olup yaş ortalaması 4,6± 4,2 (3-18) yıl idi. pH monitorizasyonu yapılan hastalar eşlik eden hastalıklar açısından değerlendirildiğinde en sık MMR±epilepsi (%32), wheezy infant/astım (%11) eşlik ediyordu. Olguların % 44'ünde ise ek hastalık yoktu. MMR±epilepsi ve astım/wheezy infant tanısı olan hastaların pH monitorizasyon parametreleri ek hastalığı olmayan hastalar ile ayrı ayrı karşılaştırıldığında diğer parametreler arasında anlamlı bir fark bulunmamakla beraber MMR±epilepsi olan hastalarda 5 dakikanın üzerinde reflü sayısının ek hastalığı olmayan olgulara göre anlamlı olarak daha fazla olduğu görüldü. Hastaların takip süreleri 4,5±3,1 (2-24 ay) idi. Bu süre içine hastalara beslenme önerilerinde bulunulduğu ve medikal tedavi uygulandığı belirlendi. 77 hastaya sadece PPI tedavisi ile, 32 hastaya PPI+prokinetik/yüzey ajanı, 165 hastaya H2 reseptör antagonisti+ prokinetik/yüzey ajanı tedavisi verildiği belirlendi. Tedavi süresi 3,9±1,8 (2-18 ay) olarak belirlendi. Olguların 12'sine tedavi değişikleri yapıldığı, izlemde 255 hastanın medikal tedavi ile düzeldiği, 14 hastaya gastrostomi, 5 hastaya fundoplikasyon uygulandığı belirlendi.Sonuç olarak, çocukluk çağı GÖRH'nın özellikle süt çocukluğu döneminde en sık öksürük ve kusmayla belirti verdiği daha büyük çocuklarda ise erişkinlerde olduğu gibi ağza acı su gelme, göğüste yanma belirtilerinin ön planda olduğu, hastaların çoğunun medikal tedaviye cevap verdiği, cevap vermeyen ve cerrahi tedaviye giden hastaların da mental motor defisitli oldukları görüldü.Anahtar kelimeler: gastroözefageal reflü hastalığı, 24-saat özefageal pH monitorizasyonu, çocukluk çağı, mental motor retardasyon
The aim of this study is determining the complaints, physical examination, imaging findings and treatment responses of children that are being followed up in Ondokuz Mayıs University Pediatric Gastroenterology Hepatology and Nutrition Department by the gastroesophageal reflux disease (GERD). For that purpose, 274 patients with that are being followed up by GERD from June 2007 to June 2011 and whose file information could be obtained were investigated as retrospectively.118 (43.1%) of patients were female, 156 (56.9%) were male and their mean age was 4.9 ± 4.2 years (1 to 16.3 years). According to age group, 67 patients (24.5%) under 1 year of age (Group-1), 80 patients (29,2%) were between 1-3 years of age (Group-2), 57 patients (20.8%) were between 4-7 years (Group-3), 47 patients (17.2%) were between 8-11 years of age (Group-4), 23 patients (8.4%) were between 12-18 years (Group-5). Complaints of patients with respiratory and gastrointestinal tract symptoms as compared with systems split in two. There were 98 patients with gastrointestinal symptoms, 41 patients with respiratory symptoms and 135 patients with both of two system symptoms The most common symptom of gastrointestinal system was womiting and the most common respiratory symptom was cough. When the sypmtoms assessed according to age groups; wheezing and cough were most common in group-1 and group-2, abdominal pain, chest pain, heartburn and regürgitation were most common in group 3, group-4 and group5.When the cases were evaluated according to diagnostic methods; 110 patients diagnosed with gastroesophageal reflux scintigraphy, 58 with 24-hour esophageal pH monitoring, 92 patients with clinically and barium graphy was applied to 9 patients and upper gastrointestinal tract endoscopy was applied to 5 patients.Between dates which are including our study, 24-hour pH monitoring is performed in 131 patients (69 male, 62 were female, mean age 4.6 ± 4.2 (3-18) years) and pathological reflux is established in 58 of them. The most common comorbidities were mental motor retardation (MMR) ± epilepsy (32%) and wheezy infant / asthma (11%). 44% of the cases have had no comorbidity. We compared pH monitoring parameters of patients who have with MMR ± epilepsy and asthma / wheezy infants with patients which have no comorbidities. There was no significant difference between these groups according to the results of reflux parameter except reflux numbers of higher than 5 minutes. This parameter was greater in patients with MMR +epilepsy than the others.Follow-up period was 4.5 ± 3.1 (2-24) months. Patients were informed about nutrition and administered some treatments. Of the patients 77 had been treated with PPI, 32 had PPI + prokinetic / surface agent and 165 patients had been treated with H2 receptor antagonist+prokinetic / surface agent. The duration of treatment was 3.9±1.8 (2-18 months). We obtained that the treatment regimes of 12 cases were changed during follow-up. 255 patients recovered with medical treatment, 5 patients all with MMR had gone to gastrostomy and fundoplication.Key words: gastroesophageal reflux disease, 24-hour esophageal pH monitoring, childhood, mental motor retardation
The aim of this study is determining the complaints, physical examination, imaging findings and treatment responses of children that are being followed up in Ondokuz Mayıs University Pediatric Gastroenterology Hepatology and Nutrition Department by the gastroesophageal reflux disease (GERD). For that purpose, 274 patients with that are being followed up by GERD from June 2007 to June 2011 and whose file information could be obtained were investigated as retrospectively.118 (43.1%) of patients were female, 156 (56.9%) were male and their mean age was 4.9 ± 4.2 years (1 to 16.3 years). According to age group, 67 patients (24.5%) under 1 year of age (Group-1), 80 patients (29,2%) were between 1-3 years of age (Group-2), 57 patients (20.8%) were between 4-7 years (Group-3), 47 patients (17.2%) were between 8-11 years of age (Group-4), 23 patients (8.4%) were between 12-18 years (Group-5). Complaints of patients with respiratory and gastrointestinal tract symptoms as compared with systems split in two. There were 98 patients with gastrointestinal symptoms, 41 patients with respiratory symptoms and 135 patients with both of two system symptoms The most common symptom of gastrointestinal system was womiting and the most common respiratory symptom was cough. When the sypmtoms assessed according to age groups; wheezing and cough were most common in group-1 and group-2, abdominal pain, chest pain, heartburn and regürgitation were most common in group 3, group-4 and group5.When the cases were evaluated according to diagnostic methods; 110 patients diagnosed with gastroesophageal reflux scintigraphy, 58 with 24-hour esophageal pH monitoring, 92 patients with clinically and barium graphy was applied to 9 patients and upper gastrointestinal tract endoscopy was applied to 5 patients.Between dates which are including our study, 24-hour pH monitoring is performed in 131 patients (69 male, 62 were female, mean age 4.6 ± 4.2 (3-18) years) and pathological reflux is established in 58 of them. The most common comorbidities were mental motor retardation (MMR) ± epilepsy (32%) and wheezy infant / asthma (11%). 44% of the cases have had no comorbidity. We compared pH monitoring parameters of patients who have with MMR ± epilepsy and asthma / wheezy infants with patients which have no comorbidities. There was no significant difference between these groups according to the results of reflux parameter except reflux numbers of higher than 5 minutes. This parameter was greater in patients with MMR +epilepsy than the others.Follow-up period was 4.5 ± 3.1 (2-24) months. Patients were informed about nutrition and administered some treatments. Of the patients 77 had been treated with PPI, 32 had PPI + prokinetic / surface agent and 165 patients had been treated with H2 receptor antagonist+prokinetic / surface agent. The duration of treatment was 3.9±1.8 (2-18 months). We obtained that the treatment regimes of 12 cases were changed during follow-up. 255 patients recovered with medical treatment, 5 patients all with MMR had gone to gastrostomy and fundoplication.Key words: gastroesophageal reflux disease, 24-hour esophageal pH monitoring, childhood, mental motor retardation
Description
Keywords
Gastroenteroloji, Çocuk Sağlığı ve Hastalıkları, Gastroözofageal Reflü, Hidrojen İyon Konsantrasyonu, Gastroenterology, Child Health and Diseases, Mental Bozukluklar, Gastroesophageal Reflux, Hydrogen-Ion Concentration, Retrospektif Çalışmalar, Mental Disorders, Retrospective Studies, Çocuklar, Children
Citation
WoS Q
Scopus Q
Source
Volume
Issue
Start Page
End Page
68