A importância da phmetria esofágica prolongada na pesquisa do refluxo gastroesofágico patológico em crianças

Abstract

In the past 20 years the association between gastroesophageal reflux and otorhinolaryngological and/or respiratory affections became more evident by many studies. At the same time it is known that regurgitation, abdominal pain, growth retard, among others signs, could be generated by gastroesophageal reflux in infants, and when these signals are present the suspicious must be considered and they could be referred to perform pH studies. Sixty children were referred to our center to perform pH monitoring with gastroesophageal reflux suspicious, with digestive symptoms, respiratory problems or otorhinolaryngological manifestations. The patients were divided in two groups: the first, with 25 children, suffering from digestive manifestations. The second, 35 patients, including otorhinolaryngological or pulmonary symptoms. The children with digestive manifestations and with otorhinolaryngological or pulmonary symptoms were included in the first group. The pH analysis were considered positive for reflux when Boix-Ochoa Index (for 8 months of age or less) or DeMeester index (for 9 months or more) were above 11.99 or 14.72, respectively. The data were also compared to the results of scintigraphic studies for reflux or endoscopic findings in 22 patients. The pH monitoring test were positive in 62% patients with digestive manifestations. In the group with otorhinolaryngological or pulmonary symptoms the positivity was only 29%. In the group of children with both affections, the positivity was 66%. In patients that performed scintigraphic test or endoscopy, the pH test positivity were similar, 63%, without correlation if these other tests were positive or not. Patients with abnormal endoscopy or positive scintigraphic tests for gastroesophageal reflux presented 37% of positivity in pH test. We conclude that pH monitoring tests could be altered mainly when referred to investigate digestive manifestations when compared to primary otorhinolaryngological or pulmonary indications. Digestive endoscopy or scintigraphic study altered do not mean positive pH test and the inverse situation could be find too. Digestive symptoms coexisting with otorhinolaryngological or pulmonary afections do not increase the positivity frequency of the pH tests when compared with digestive manifestations exclusively.

Diagnóstico da doença do refluxo gastroesofágico: opções e critérios

“…O surgimento de sondas e eletrodos extremamente finos e macios tem feito com que o exame seja cada vez mais confortável, muito bem aceito, inclusive por crianças, nas quais talvez seja o recurso diagnóstico de eleição para as várias afecções, inclusive extradigestivas, decorrentes do refluxo gastroesofágico (4) . Limitações existem, como em todo procedimento biológico (3) .…”

“…4 a endoscopia, mas este também não é recurso completo para diagnóstico da DRGE. Evidencia o aspecto da mucosa com nitidez, mas mesmo assim os critérios de avaliação da agressão permanecem controversos e as classificações da esofagite variam a toda hora.…”