抑酸剂不能改善同患哮喘和胃食管反流儿童的呼吸道症状

Background: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven. A im: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD. Methods: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index ≥5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of tre atment with omeprazole 20 mg daily or placebo. The groups were similar in age, g ender, mean reflux index, and asthma severity. Primary endpoints were asthma sym ptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) a nd quality of life (PAQLQ). Secondary endpoints were changes in lung function an d the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression. Results: The c hange in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95%CI -0.1 to 2.65) and 1.28 (9 5%CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95%CI 0. 29 to 0.95) in the omeprazole group compared to 0.50 (95%CI 0.29 to 0.70) in th e placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index < 5 .0) under omeprazole treatment. Conclusion: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.

儿童胃食管反流病:症状与pH值监测之间的关系

Objective. The prevalence of symptoms associated with gastroesophageal reflux disease (GERD) in patients with abnormal results of pH monitoring has been investigated in adults and infants. A questionnaire suitable for children between 7 and 16 years of age has been proposed, but this tool has so far not been validated. In the present study the items of the questionnaire are validated against results from an esophageal 24h study of pH. Material and methods. Ninety-nine children aged from 7 to 16 years referred from two outpatient clinics for suspected GERD completed the 7-point questionnaire regarding symptoms during the week prior to a pH study. The frequency of symptoms was investigated in patients with abnormal versus normal pH (reflux index >/< 5.0). A group of healthy children (n = 284) served as controls to estimate the frequency of symptoms in the normal population. Results. It was found that 37/99 (37%) of patients had an abnormal pH study result. Regurgitation/ vomiting yielded the best symptom discrimination, and was reported by 46%with abnormal versus 24%with normal pH-study results (p =0.029). A weighted score including the five best discriminating symptoms was positive in 75%versus 44%(OR 3.78, CI 1.52-9.37, p =0.006). In a comparison of children with abnormal pH studies and healthy controls, a correct diagnosis based on five symptoms could be obtained in 75%and 94%, respectively. Conclusions. A relatively weak association was found between reflux symptoms and a positive pH study in 7-16-year-old children referred for pH monitoring. Thus, the questionnaire is not a diagnostic tool, and its potential use is limited to epidemiological studies.

复发性腹痛:5年回顾研究

To explore the long- term prognosis for children referred for recurrent abdo minal pain (RAP), 44 children investigated for RAP 5 y ago were compared to a gr oup of controls (n = 88). The former RAP patients reported RAP, headache and sch ool absence more frequently than controls. Conclusion: A high proportion of chil dren referred with RAP have persistent symptoms, with more headache and school a bsence than controls. The diagnostic subgroup did not predict persistence of abd ominal pain.