Mechanisms of Aerodigestive Symptoms in Infants with Varying Acid Reflux Index Determined by Esophageal Manometry
Mechanisms of Aerodigestive Symptoms in Infants with Varying Acid Reflux Index Determined by Esophageal Manometry
复制标题
DOI：
10.1016/j.jpeds.2018.10.051
复制
发表时间：
2019-03-01
影响因子：
5.1
通讯作者：
Jadcherla, Sudarshan R.
中科院分区：
文献类型：
--
作者：
Collins, Carissa R.;Hasenstab, Kathryn A.;Jadcherla, Sudarshan R.
目的探讨胃食管反流病（GERD）症状的严重程度是否与婴儿症状的产生有关，胃食管反流病（GERD）症状的严重程度由酸反流指数（ARI）、刺激介质和刺激体积在激发性食管测压中确定。（范围：23.4-39.4周），中位研究时间为41.0周（范围，34.6-48.0周）月经后年龄，使用24小时pH-阻抗法确定ARI严重程度，然后进行激发性食管测压和分级食管中段输注（0.1-5.0 mL）空气、水和苹果汁。采用线性混合模型和广义估计方程比较ARI严重程度类别之间的蠕动反射和症状特征。结果分析了2635个单独食管刺激对反射和症状的影响。蠕动反射发生在1880次输注（71%）中，439次输注（17%）中观察到身体、心肺和感觉症状。不同ARI严重程度类别的症状患病率无差异（ARI 7，16%; P= 1.0）。症状和蠕动反应随着刺激量的增加而增加（所有媒体，P <0.001）。结论症状和蠕动反射是食管中段灌注引起的几种神经感觉和神经运动通路的募集的表现。ARI严重程度分级在症状产生中不起作用，表明不应诊断GERD，也不应仅根据症状分配严重程度。随着刺激量的增加，注意到症状发生率增加，这在引起蠕动清除反射时提供了受体、传入神经和传出神经的激活增加。
Objective To test whether symptom generation in infants is related to the severity of gastroesophageal reflux disease (GERD) symptoms as determined by the Acid Reflux Index (ARI), stimulus media, and stimulus volume during provocative esophageal manometry.Study design Symptomatic neonates (n = 74) born at a median of 28.9 weeks gestation (range, 23.4-39.4 weeks) were studied at a median of 41.0 weeks (range, 34.6-48.0 weeks) postmenstrual age using 24-hour pH-impedance methods to determine ARI severity, followed by provocative esophageal manometry with graded midesophageal infusions (0.1-5.0 mL) of air, water, and apple juice. Peristaltic reflexes and symptom characteristics were compared among ARI severity categories using linear mixed models and generalized estimating equations.Results The effects of 2635 separate esophageal stimuli on reflexes and symptoms were analyzed. Peristaltic reflexes occurred in 1880 infusions (71%), and physical, cardiorespiratory, sensory symptoms were seen in 439 infusions (17%). Symptom prevalence did not differ across the ARI severity categories (ARI 7, 16%; P= 1.0). Symptom and peristaltic responses increased with incremental stimulus volumes (all media, P < .001).Conclusions Symptoms and peristaltic reflexes are manifestations of the recruitment of several neurosensory and neuromotor pathways evoked by mid-esophageal infusions. ARI severity grade plays no role in symptom generation, indicating that GERD should not be diagnosed and severity should not be assigned based on symptoms alone. An increase in symptom occurrence was noted with increasing stimulus volumes, which provided increased activation of receptors, afferents, and efferents in evoking peristaltic clearance reflexes.