AIM: To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD). METHODS: 264 children suspected ...AIM: To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD). METHODS: 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age χ = 20.78 ± 17.23 mo). The outcomes of this study, immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient, enabled to qualify children into particular study groups. RESULTS: 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32 (12.1%) of them had CMA/FA (group 4-reference group), and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of: number of episodes of acid GER, episodes of acid GER lasting > 5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed. CONCLUSION: 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.展开更多
BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.T...BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.展开更多
Background: gastroesophageal reflux (GER) plays a major role in the pathogenesis of pediatric chronic airway disease. Esophageal pH-monitoring (epHM) is the diagnostic gold standard for acid GER. To date, there are no...Background: gastroesophageal reflux (GER) plays a major role in the pathogenesis of pediatric chronic airway disease. Esophageal pH-monitoring (epHM) is the diagnostic gold standard for acid GER. To date, there are no cut-off values for chronically coughing children ruling out relevant GER. Methods: 24-hour, double-channel epHM was performed in 549 children (3 months to 16 years old) with chronic pulmonary disease. We stratified according to age as follows: ≤ 1.5 years, > 1.5 - 4 years, > 4 - 8 years, > 8 12 - 16 years. Following parameters were calculated for both channels: total number of reflux episodes, number of reflux episodes > 5 minutes, duration of the longest reflux episode, and reflux index. Results: according to the above given age classification, the median number of reflux episodes in the lower esophagus was 31, 27, 32, 34, and 42 and for the upper esophagus 20, 13, 15, 14, and 11 respectively. The median reflux index at the distal esophagus was 2.55, 2.1, 2.3, 2.15, and 1.9;at the upper esophagus it was 1.4, 1.0, 1.1, 0.9, and 0.6 respectively. Conclusions: our data contribute useful support to the evaluation of pediatric airway disease. We provide reference values for decisions in the exploration of children with airway disorders and suspected GER.展开更多
AIM:To evaluate pre-lung transplant acid reflux on p H-testing vs corresponding bolus reflux on multichannel intraluminal impedance(MII) to predict early allograft injury.METHODS:This was a retrospective cohort study ...AIM:To evaluate pre-lung transplant acid reflux on p H-testing vs corresponding bolus reflux on multichannel intraluminal impedance(MII) to predict early allograft injury.METHODS:This was a retrospective cohort study of lung transplant recipients who underwent pretransplant combined MII-p H-testing at a tertiary care center from January 2007 to November 2012. Patients with pre-transplant fundoplication were excluded. Time-to-event analysis was performed using a Cox proportional hazards model to assess associations between measures of reflux on MII-p H testing and early allograft injury. Area under the receiver operating characteristic(ROC) curve(c-statistic) of the Cox model was calculated to assess the predictive value of each reflux parameter for early allograft injury. Six p H-testing parameters and their corresponding MIImeasures were specified a priori. The p H parameters were upright,recumbent,and overall acid reflux exposure; elevated acid reflux exposure; total acid reflux episodes; and acid clearance time. The corresponding MII measures were upright,recumbent,and overall bolus reflux exposure; elevated bolus reflux exposure; total bolus reflux episodes; and bolus clearance time.RESULTS:Thirty-two subjects(47% men,mean age:55 years old) met the inclusion criteria of the study. Idiopathic pulmonary fibrosis(46.9%) repres e n t e d t h e m o s t c o m m o n p u l m o n a r y d i a g n o s i s leading to transplantation. Baseline demographics,pre-transplant cardiopulmonary function,number of lungs transplanted(unilateral vs bilateral),and posttransplant proton pump inhibitor use were similar between reflux severity groups. The area under the ROC curve,or c-statistic,of each acid reflux parameter on pre-transplant p H-testing was lower than its bolus reflux counterpart on MII in the prediction of early allograft injury. In addition,the development of early allograft injury was significantly associated with three pre-transplant MII measures of bolus reflux:overall reflux exposure(HR = 1.18,95%CI:1.01-1.36,P = 0.03),recumbent reflux exposure(HR = 1.25,95%CI:1.04-1.50,P = 0.01) and bolus clearance(HR = 1.09,95%CI:1.01-1.17,P = 0.02),but not with any p Htesting parameter measuring acid reflux alone.CONCLUSION:Pre-transplant MII measures of bolus reflux perform better than their p H-testing counterparts in predicting early allograft injury post-lung transplantation.展开更多
基金Supported by Grant of State Committee for Scientific Research (KBN) No 4P05E 04719
文摘AIM: To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD). METHODS: 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age χ = 20.78 ± 17.23 mo). The outcomes of this study, immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient, enabled to qualify children into particular study groups. RESULTS: 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32 (12.1%) of them had CMA/FA (group 4-reference group), and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of: number of episodes of acid GER, episodes of acid GER lasting > 5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed. CONCLUSION: 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.
文摘BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.
文摘Background: gastroesophageal reflux (GER) plays a major role in the pathogenesis of pediatric chronic airway disease. Esophageal pH-monitoring (epHM) is the diagnostic gold standard for acid GER. To date, there are no cut-off values for chronically coughing children ruling out relevant GER. Methods: 24-hour, double-channel epHM was performed in 549 children (3 months to 16 years old) with chronic pulmonary disease. We stratified according to age as follows: ≤ 1.5 years, > 1.5 - 4 years, > 4 - 8 years, > 8 12 - 16 years. Following parameters were calculated for both channels: total number of reflux episodes, number of reflux episodes > 5 minutes, duration of the longest reflux episode, and reflux index. Results: according to the above given age classification, the median number of reflux episodes in the lower esophagus was 31, 27, 32, 34, and 42 and for the upper esophagus 20, 13, 15, 14, and 11 respectively. The median reflux index at the distal esophagus was 2.55, 2.1, 2.3, 2.15, and 1.9;at the upper esophagus it was 1.4, 1.0, 1.1, 0.9, and 0.6 respectively. Conclusions: our data contribute useful support to the evaluation of pediatric airway disease. We provide reference values for decisions in the exploration of children with airway disorders and suspected GER.
文摘AIM:To evaluate pre-lung transplant acid reflux on p H-testing vs corresponding bolus reflux on multichannel intraluminal impedance(MII) to predict early allograft injury.METHODS:This was a retrospective cohort study of lung transplant recipients who underwent pretransplant combined MII-p H-testing at a tertiary care center from January 2007 to November 2012. Patients with pre-transplant fundoplication were excluded. Time-to-event analysis was performed using a Cox proportional hazards model to assess associations between measures of reflux on MII-p H testing and early allograft injury. Area under the receiver operating characteristic(ROC) curve(c-statistic) of the Cox model was calculated to assess the predictive value of each reflux parameter for early allograft injury. Six p H-testing parameters and their corresponding MIImeasures were specified a priori. The p H parameters were upright,recumbent,and overall acid reflux exposure; elevated acid reflux exposure; total acid reflux episodes; and acid clearance time. The corresponding MII measures were upright,recumbent,and overall bolus reflux exposure; elevated bolus reflux exposure; total bolus reflux episodes; and bolus clearance time.RESULTS:Thirty-two subjects(47% men,mean age:55 years old) met the inclusion criteria of the study. Idiopathic pulmonary fibrosis(46.9%) repres e n t e d t h e m o s t c o m m o n p u l m o n a r y d i a g n o s i s leading to transplantation. Baseline demographics,pre-transplant cardiopulmonary function,number of lungs transplanted(unilateral vs bilateral),and posttransplant proton pump inhibitor use were similar between reflux severity groups. The area under the ROC curve,or c-statistic,of each acid reflux parameter on pre-transplant p H-testing was lower than its bolus reflux counterpart on MII in the prediction of early allograft injury. In addition,the development of early allograft injury was significantly associated with three pre-transplant MII measures of bolus reflux:overall reflux exposure(HR = 1.18,95%CI:1.01-1.36,P = 0.03),recumbent reflux exposure(HR = 1.25,95%CI:1.04-1.50,P = 0.01) and bolus clearance(HR = 1.09,95%CI:1.01-1.17,P = 0.02),but not with any p Htesting parameter measuring acid reflux alone.CONCLUSION:Pre-transplant MII measures of bolus reflux perform better than their p H-testing counterparts in predicting early allograft injury post-lung transplantation.
