Primary duodenogastric reflux in children and adolescents
Primary duodenogastric reflux in children and adolescents
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DOI：
10.1007/s00431-003-1259-y
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发表时间：
2003-09-01
影响因子：
3.6
通讯作者：
Buts, JP
中科院分区：
文献类型：
--
作者：
Hermans, D;Sokal, EM;Buts, JP
原发性胃反流是一种罕见的疾病，在成人尚未被记录在儿童。6例年轻患者，年龄4.5至16.5岁（中位数13.5岁），表现为持续1至84个月（中位数8个月）的非典型反流症状，对经典抗酸剂治疗无反应。在所有六名患者中，24小时胃胆汁测定显示胆汁暴露过多，吸光度范围为0.25至0.60。高于0.25吸光度阈值的时间分数（仰卧期）范围为30%至75%，而健康成人的第95百分位值为31%。在所有受试患者中，肝亚氨基二乙酸造影显示发生了大量胃内反流，5名患者中有4名出现碱性偏移（24小时食管下段pH监测中pH > 8的时间分数），范围为4.2%至20%（对照值为0.0%至2.9%）。内镜检查发现大量胆汁性胃漏（6/6）和慢性幽门螺杆菌阴性胃炎（2/6）。每日给予西沙必利、硫糖铝伴或不伴奥美拉唑，5例患者在15天内症状改善。这种治疗是无效的一名患者成为无痔后，只有手术十二指肠开关胃底折叠术进行。结论：原发性胃反流是一种罕见的前肠疾病的原因不明，发生在儿童晚期。如果怀疑，24小时胃内胆汁测定似乎是一个有用的调查，以确认诊断。
Primary duodenogastric reflux is a rare disorder in adults which has not yet been documented in children. Six young patients, aged 4.5 to 16.5 years (median 13.5 years) presented with atypical reflux symptoms persisting from 1 to 84 months (median 8 months) and unresponsive to classical antacid therapy. In all six patients, 24 h gastric bilimetry showed excessive bile exposures for absorbances ranging from 0.25 to 0.60. The fraction of time (supine period) above the 0.25 absorbance threshold ranged from 30% to 75% while the 95th percentile value for healthy adults is 31%. In all patients tested, hepato-iminodiacetic acid scintigraphy revealed the occurrence of a massive duodenogastric reflux and four out of five patients had an alkaline shift (fraction of time pH > 8 on 24 h lower oesophageal pH monitoring) ranging from 4.2% to 20% (control values 0.0% to 2.9%). Endoscopic findings included abundant bilious gastric leak (6/6) and chronic prepyloric Helicobacter pylori negative gastritis (2/6). Daily administration of cisapride, sucralfate with or without omeprazole resulted in an improvement of symptoms in five patients within 15 days. This treatment was ineffective in one patient who became symptom-free only after a surgical duodenal switch with fundoplication was performed. Conclusion: Primary duodenogastric reflux is a rare foregut disorder of unknown origin occurring in late childhood. If suspected, 24 h intragastric bilimetry appears to be a useful investigation to confirm the diagnosis.