DIAGNOSTIC VALUE OF MORPHOLOGICAL CHANGES IN GASTROESOPHAGEAL REFLUX DISEASE IN BIOPSY MATERIAL OF THE DISTAL ESOPHAGUS IN ADOLESCENTS SICKLY WITH ACUTE RESPIRATORY DISEASES
Abstract
The article dedicated to the problem of the diagnostic value of morphological changes in gastroesophageal reflux disease in the biopsy of the distal esophagus in pubertal children of childbearing age.
Aim of the research is to investigate the diagnostic value of morphological changes in gastroesophageal reflux disease in esophageal biopsy material in adolescents sickly with acute respiratory diseases.
Methodology. The objective of the study was achieved through examination of 90 adolescents (10 to 16 years old, average age 13.1±3.54 years) kept under observation at the Children’s Clinical Hospital No. 9 of Kyiv and on the basis of the Department of Pediatrics No. 1 Center of Primary Health Care No. 4 of the Desnianskyi district of Kyiv. All adolescents belonged to the group of sickly with a number of respiratory diseases averaging 6-8 times a year, lasting from 8 to 18 days (on average 12.8±5.41 days). All children have undergone endoscopic examination of the esophagus, stomach and duodenum with the esophagus mucosa biopsy using the OLYMPUS GIF-P3 flexible fiberscope.
Results. It was found that the least valuable diagnostic feature in the morphological examination of the mucous membrane of the distal esophagus in the pain-causing children with GERD was thickening of the epithelium with a sensitivity of 13,0 %, a specificity of 96.0 %, and total value of 65.0 %. It has been proved that hyperplasia of cells of the basal layer of the mucous membrane of the distal esophagus at the GERD in the infected children is 46.7 % (specificity – 93.3 %, the total value is 75.6 %). Increase in the number of papillae and their prolongation in 33.3 % cases (sensitivity – 33.3 %, specificity – 93.3 %, overall diagnostic value – 70.8 %).
Conclusion. The peculiarity of the morphological manifestations of GERD in childbearing children is dystrophic changes in keratocytes in the superficial parts of the multilayer squamous epithelium, which are detected at 100.0 % of patients (specificity is 93.3 %, total value is 96.8 %), with parakeratosis centers at 13.3 % of cases. It has been shown that a frequent and diagnostically valuable indication is inflammatory infiltration of the esophageal mucosa, which are verified in all cases (100.0 %, with dilatation and hyperemia in 46.7 % of patients (specificity – 40.0 %, total value – 81.3 %).
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References
Boyarska, L. M., Ivanova, K. O., Skalozubova, I. B. (2012). Clinical and Functional Features of Gastroesophageal Reflux Disease in Children and Adolescents. Pathology, 1 (24), 26–30.
Zhykhareva, N. S. (2013), Gastroesophageal Reflux Disease in Children. Medical Council, 3, 34–41.
Tang, M., Blake, K. V., Lima, J. J., Mougey, E. B., Franciosi, J., Schmidt, S. et. al. (2019). Genotype tailored treatment of mild symptomatic acid reflux in children with uncontrolled asthma (GenARA): Rationale and methods. Contemporary Clinical Trials, 78, 27–33. doi: http://doi.org/10.1016/j.cct.2019.01.009
Chen, X., Peng, W.-S., Wang, L. (2019). Etiology analysis of nonspecific chronic cough in children of 5 years and younger. Medicine, 98 (3), e13910. doi: http://doi.org/10.1097/md.0000000000013910
Tack, J., Pandolfino, J. E. (2018). Pathophysiology of Gastroesophageal Reflux Disease. Gastroenterology, 154 (2), 277–288. doi: http://doi.org/10.1053/j.gastro.2017.09.047
Ruigómez, A., Wallander, M.-A., Lundborg, P., Johansson, S., Rodriguez, L. A. G. (2009). Gastroesophageal reflux disease in children and adolescents in primary care. Scandinavian Journal of Gastroenterology, 45 (2), 139–146. doi: http://doi.org/10.3109/00365520903428606
Nakayama, Y., Ida, S. (2017). Endoscopic findings of esophagogastric junction in children. Digestive Endoscopy, 29, 11–17. doi: http://doi.org/10.1111/den.12793
Gyawali, C. P., Fass, R. (2018). Management of Gastroesophageal Reflux Disease. Gastroenterology, 154 (2), 302–318. doi: http://doi.org/10.1053/j.gastro.2017.07.049
Macchini, F., Zanini, A., Pasqua, N., Farris, G., Canazza, L., Gentilino, V. et. al. (2015). Endoscopic Surveillance for Congenital Diaphragmatic Hernia: Unexpected Prevalence of Silent Esophagitis. European Journal of Pediatric Surgery, 26 (3), 291–295. doi: http://doi.org/10.1055/s-0035-1552568
Hoshihara, Y., Iwakiri, K. (2016) Endoscopic classification of reflux esophagitis. Nihon Rinsho, 74 (8), 1262–1267.
Tutar, E., Kutluk, G., Bayrak, N. A., Ataizi Celikel, C., Pehlivanoglu, E., Ertem, D. (2009). What is the diagnostic utility of endoscopic scoring systems in children? The Turkish Journal of Gastroenterology, 24 (1), 22–29. doi: http://doi.org/10.4318/tjg.2013.0700
Numans, M. E., De Wit, N. J. (2003). Reflux symptoms in general practice: diagnostic evaluation of the Carlsson-Dent gastro-oesophageal reflux disease questionnaire. Alimentary Pharmacology and Therapeutics, 17 (8), 1049–1055. doi: http://doi.org/10.1046/j.1365-2036.2003.01549.x
Hoshino, M., Omura, N., Yano, F., Tsuboi, K., Yamamoto, S. R., Akimoto, S. et. al. (2018). Impact of reflux esophagitis on the esophageal function before and after laparoscopic fundoplication. Esophagus, 15 (4), 224–230. doi: http://doi.org/10.1007/s10388-018-0618-8
Kasyap, A. K., Sah, S. K., Chaudhary, S. (2018). Clinical spectrum and risk factors associated with asymptomatic erosive esophagitis as determined by Los Angeles classification: A cross-sectional study. PLOS ONE, 13 (2), e0192739. doi: http://doi.org/10.1371/journal.pone.0192739
Vakil, N. (2010). Disease definition, clinical manifestations, epidemiology and natural history of GERD. Best Practice & Research Clinical Gastroenterology, 24 (6), 759–764. doi: http://doi.org/10.1016/j.bpg.2010.09.009
Houghton, L. A., Smith, J. A. (2017). Gastro-oesophageal reflux events: just another trigger in chronic cough? Gut, 66 (12), 2047–2048. doi: http://doi.org/10.1136/gutjnl-2017-314027
Evsyutina, Yu. V., Trukhmanov, A. S., Ivashkin, V. T. (2015). Systemic Immune Response in Patients with Gastroesophageal Reflux Disease. Russian Journal of Gastroenterology, Hepatology and Coloproctoly, 5, 32–38.
Leason, S. R., Barham, H. P., Oakley, G., Rimmer, J., DelGaudio, J. M., Christensen, J. M. et. al. (2017). Association of gastro-oesophageal reflux and chronic rhinosinusitis: systematic review and meta-analysis. Rhinology Journal, 55 (1), 3–16. doi: http://doi.org/10.4193/rhin16.177
Friesen, C. A., Rosen, J. M., Schurman, J. V. (2016). Prevalence of overlap syndromes and symptoms in pediatric functional dyspepsia. BMC Gastroenterology, 16 (1), 75. doi: http://doi.org/10.1186/s12876-016-0495-3
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