Особливості клінічного перебігу бронхіальної астми, поєднаної з гастроезофагеальною рефлюксною хворобою, у дітей

Abstract

Among the comorbid conditions in children with asthma a significant place is occupied by lesions of the upper digestive tract+in particular, gastroesophageal reflux disease (GERD). It is known that asthma can provoke the development of reflux, and reflux in turn leads to a worsening of the course of asthma. Scientific studies indicate a better ability to control asthma in children after appropriate treatment for GERD. Purpose — to study the features of the clinical course of asthma combined with gastroesophageal reflux disease in children. Materials and methods. Ninety+nine children aged 6–17 years with asthma of varying severity and level of control were examined. These children which were randomly divided into two groups: group 1–79 children with asthma combined with GERD, and group 2–20 children with asthma without GERD. A questionnaire was administered, an assessment of day and night symptoms of asthma according to the scoring system was conducted, and an ACT test according to age was performed on all examined children. With the consent of the parents, twenty-two children who had complaints characteristic of gastrointestinal lesions, underwent fibroesophagogastroduodenoscopy with biopsy from the proximal and distal esophageal mucosa. Results. In children with asthma combined with GERD, atopic dermatitis is probably more common (in 46.8% of patients), and symptoms of hypersensitive reactions to food are registered (in 74.6% of patients). Children in group 1, in contrast to children in group 2, had a longer and more severe course of asthma and probably more frequent nocturnal symptoms of the disease, which was associated with poorer control of asthma and the need for bronchodilator therapy (8.5±0.5 inhalations per month against 4.5±0.5 inhalations per month, respectively, p<0,05). Peculiarities of GERD in children with asthma were: nonspecific complaints, catarrhal changes of the lower third of the esophagus (reflux esophagitis in 98.7%), focal hyperplasia of the basal layer of the epithelium and intraepithelial eosinophilia up to 5% (9%). Girls and boys of different ages experience significant differences in complaints from the gastrointestinal tract. Conclusions. The presence of GERD has been shown to affect the control of asthma in children, associated with nocturnal symptoms, the need for bronchodilator therapy, more severe and prolonged course of the disease, concomitant atopic dermatitis and food hypersensitivity reactions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Keywords. asthma, gastroesophageal reflux disease, children.