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Dziekiewicz M, Marczak H, Banasiuk M, Aksionchyk M, Krenke K, Banaszkiewicz A. Characteristics of gastroesophageal reflux disease in children with interstitial lung disease. Pediatr Pulmonol 2023; 58:171-177. [PMID: 36196557 DOI: 10.1002/ppul.26176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/10/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Childhood interstitial lung disease (chILD) is a rare group of respiratory tract disorders. One of the factors suggested to be associated with its etiopathogenesis is microaspiration related to gastroesophageal reflux disease (GERD). The aim of the present study was to determine the frequency and characteristics of GERD in children with chILD, with a particular focus on proximal GER episodes. METHODS This was a prospective cross-sectional study. Consecutive patients with chILD underwent 24-h multichannel intraluminal pH-impedance monitoring. Different types of gastroesophageal reflux episodes (GER) were recorded and compared with regard to the GERD diagnosis. RESULTS Sixty-two children (median age of 1.22 years) were included. GERD was diagnosed in 20 (32.3%) of them. The GERD (+) and GERD (-) subgroups differed mainly in their esophageal exposure to acid content (2.9 vs. 1.0%, p = 0.02) and bolus exposure (3.0 vs. 1.4%, p < 0.0001), as well as total number of GER (72.5 vs. 42.0 p = 0.0004), acid GER (35.5 vs. 15.0 p = 0.004), and acid proximal GER (21.0 vs. 12.0 p = 0.02). There were no differences in the number of proximal GER comparing GERD (+) and GERD (-) subgroups. CONCLUSIONS The frequency of GERD seems to be relatively high in the population of children with chILD used in this study. However, it has not demonstrated an association between proximal GER and GERD diagnosis in chILD, which casts uncertainty over the microaspiration theory proposed to link the two diseases. The latter conclusion, however, needs to be confirmed using more accurate aspiration assessment methods.
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Affiliation(s)
- Marcin Dziekiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Banasiuk
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Marina Aksionchyk
- Department of Pediatric Gastroenterology, Diagnostic Division, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Belarus
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
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Merritt JL, Quinonez RA, Bonkowsky JL, Franklin WH, Gremse DA, Herman BE, Jenny C, Katz ES, Krilov LR, Norlin C, Sapién RE, Tieder JS. A Framework for Evaluation of the Higher-Risk Infant After a Brief Resolved Unexplained Event. Pediatrics 2019; 144:peds.2018-4101. [PMID: 31350360 DOI: 10.1542/peds.2018-4101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/24/2022] Open
Abstract
In 2016, the American Academy of Pediatrics published a clinical practice guideline that more specifically defined apparent life-threatening events as brief resolved unexplained events (BRUEs) and provided evidence-based recommendations for the evaluation of infants who meet lower-risk criteria for a subsequent event or serious underlying disorder. The clinical practice guideline did not provide recommendations for infants meeting higher-risk criteria, an important and common population of patients. Therefore, we propose a tiered approach for clinical evaluation and management of higher-risk infants who have experienced a BRUE. Because of a vast array of potential causes, the initial evaluation prioritizes the diagnosis of time-sensitive conditions for which delayed diagnosis or treatment could impact outcomes, such as child maltreatment, feeding problems, cardiac arrhythmias, infections, and congenital abnormalities. The secondary evaluation addresses problems that are less sensitive to delayed diagnosis or treatment, such as dysphagia, intermittent partial airway obstruction, and epilepsy. The authors recommend a tailored, family-centered, multidisciplinary approach to evaluation and management of all higher-risk infants with a BRUE, whether accomplished during hospital admission or through coordinated outpatient care. The proposed framework was developed by using available evidence and expert consensus.
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Affiliation(s)
- J Lawrence Merritt
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - Ricardo A Quinonez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joshua L Bonkowsky
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.,Brain and Spine Center, Primary Children's Hospital, Salt Lake City, Utah
| | - Wayne H Franklin
- Department of Pediatrics, Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - David A Gremse
- Department of Pediatrics, University of South Alabama, Mobile, Alabama
| | - Bruce E Herman
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Carole Jenny
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Eliot S Katz
- Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Leonard R Krilov
- Department of Pediatrics, New York University Winthrop, Mineola, New York; and
| | - Chuck Norlin
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Robert E Sapién
- Department of Emergency Medicine, Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - Joel S Tieder
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
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