Рrediction risk factors of gastroesophageal reflux disease in children and adolescents with chronic gastroduodenal pathology

Abstract

Introduction. According to the modern literature gastroesophageal reflux disease (GERD) is multifactorial illness. The main risk factors of its development are acid-peptic factor, Н.pylori, the autonomic nervous system dysfunction, rapid growth, heredity, burdened perinatal history, dysplasia of connective tissue structures (DCTS), environmental factors and lifestyle. Among the contradictory questions is intercurrent factors influence on the development and course of the disease. Aim of the work. To determine the risk factors for GERD in children and adolescents with chronic gastroduodenal pathology with the creation of mathematical forecasting model of the disease development and course. Materials and methods. The study involved 138 children with chronic gastroduodenal pathology who were treated inZaporozhyeCityPediatricHospital #5, aged 9 to 17 years. The main group consisted of 97 children with GERD (Group 1 - 46 children with GERD with esophagitis, Group 2 - GERD without esophagitis), comparison group comprised 41 children without clinical and endoscopic manifestations of the esophagus pathology. The following methods were conducted: clinical and medical history, instrumental - fibroesophagogastroduodenoscopy, intragastric pH-metry, ambulatory around-the clock pH monitoring in the esophagus, functional - Holter cardiac monitoring, respiratory HELIK urease test, mathematics and statistics - variational statistics, correlation analysis, binary logistic regression and multivariate regression analysis. Study results. According to the clinical and anamnestic analysis identified risk factors for GERD in children with chronic gastroduodenal pathology: hereditary predisposition (RR=1,79(1,27-2,66), р<0,05), abnormal pregnancy (ВР=1,62(1,31-1,81), р<0,05), early artificial feeding (RR = 1.31 (1,03-1,6, р<0,05), the presence of neurological symptoms during the first year life (RR = 1,32 (1,01-1,51), p <0.05), impaired diet (RR = 1,92 (1,24-2,82), p <0,05). Presence of at least five DCTS symptoms (and phenotypic manifestations of the internal organs, including the heart) was found in almost 70.0% of children with GERD, which is significantly more than in children in control group (2 times). For 34.8% of children with GERD with esophagitis had sympathicotonia (p <0.05) to 43.5% - vagotonia and to 21.7% - eytoniya (p <0,05). In 29.0% of children with GERD without esophagitis sympathicotonia was registered and the same number - vagotonia, eytoniya - in 42.0%. Risk factors of the GERD development in children with chronic gastroduodenal pathology are: high levels of trait anxiety (β = 2,34), breach of vegetative homeostasis (β = 2,34), pathological pregnancy (β = 2,16), duration of disease more 2 years (β = 1,13), a violation of the diet (β = 1,04), heredity (β = 0,83), all of which increases the risk of GERD almost 40 times. The frequency of relapses during the year depends largely on autonomic dysfunction (β = -0,47), duration of smoking (β = 0,49), high trait anxiety (β = 0,31), of gastric secretion (β = 0, 28), diet (β = 0,25) and, lesser - of gastrointestinal disease duration more than 2 years (β = 0,16). Conclusion. The results allow practicing physicians to predict the risk of GERD in children hospitalized with complains on the gastrointestinal tract. Appropriate preventive measures with the exception of the determined trigger factors not only predict its development, but also reduce the number of complications and recurrence disease, prolong remission term.

Keywords

• gastroesophageal reflux disease
• risk factors
• forecasting
• children
• adolescents