Гастроэзофагеальная рефлюксная болезнь у детей: аспекты клиники и диагностики с акцентом на использование внутрипищеводной рН-импедансометрии

Abstract

Objective. To analyze clinical manifestations and findings of impedance pH monitoring in children with suspected gastroesophageal reflux disease (GERD). Patients and methods. This study included 237 children with clinical manifestations of GERD who underwent esophageal 24-h impedance pH monitoring, esophagogastroduodenoscopy (EGD), and barium swallow X-ray. Results. All participants with true GERD were divided into four subgroups according to their EGD results: A1 – erosive disease with high acid exposure time (AET) (29%), А2 – non-erosive disease with high AET (41%), B1 – erosive disease with a high number of reflux episodes (10%), and B2 – non-erosive disease with a high number of reflux episodes (20%). Esophageal 24-h impedance pH monitoring demonstrated that the number of reflux episodes was significantly higher in A1 group than in A2 group (р < 0.001). Esophageal symptoms prevailed in children with erosive disease (groups A1 and B1), whereas patients with nonerosive disease (groups A2 and B2) primarily presented with mixed symptoms (esophageal and extraesophageal). Conclusion. The majority of GERD patients in our sample were boys (65.1%). Non-erosive disease was more common (61%) according to EGD findings. Esophageal 24-h impedance pH monitoring demonstrated significant differences in the number of reflux episodes between the groups A1 and A2. Patients in group A1 had more frequent reflux episodes than patients in group A2 (p < 0.0001). Key words: gastroesophageal reflux disease, non-erosive reflux disease, esophageal 24-h impedance pH monitoring