Nikaki K., Rybak A., Nakagawa K., Rawat D., Woodland P., Borrelli O., Sifrim D. Diagnosis of rumination syndrome in children with ambulatory impedance-pH monitoring. P1382. UEG Journal, 2019, V.7(8S) iv. Abstract issue, p. 749.
Diagnosis of rumination syndrome in children with ambulatory impedance-pH monitoring
Nikaki K.1, Rybak A.2, Nakagawa K.1, Rawat D.3, Woodland P.1, Borrelli O.2, Sifrim D.1
Перевод на русский язык: Диагностика синдрома руминации у детей с помощью рН-импедансометрии
1 Wingate Institute for Neurogastroenterology, QMUL, London, United Kingdom,
2 Great Ormond Street Hospital, Gastroenterology Department, London, United Kingdom,
3 Royal London Hospital, Paediatric Gastroenterology, London, United Kingdom
Contact E-Mail Address: kornilia_nikaki (a) hotmail.com
Introduction: According to the Rome IV criteria the diagnosis of rumination in children is based on typical symptoms during clinical evaluation. High resolution manometry/impedance (HRM/Z) can be used to confirm the clinical suspicion of rumination but is rather poorly tolerated in children and only records one postprandial period.
Aims & Methods: The aim of our study was to identify a specific diagnostic pattern of rumination during ambulatory Impedance-pH-metry (MII-pH).
We retrospectively assessed MII-pH tracings from children with clinical diagnosis of rumination syndrome confirmed by HRM/Z (minimal 2 typical rumination episodes in postprandial evaluation). We then compared the MII-pH parameters of these patients with those from children with GERD and “non-GERD” children (investigated for possible GERD but with normal MII-pH). We established cut-off levels for significant MII-pH parameters and developed a rumination-specific scoring system. We then validated the scoring system on another group of patients who underwent both HRM/Z and MII-pH (traces scored blindly).
Results: We identified 12 children with confirmed diagnosis of rumination based on HRM/Z findings (median age: 13.9 years, 6M:6F). Another 18 children were identified with GERD (median age: 8.1 years, 8M:10F) and 12 children with non-GERD (median age: 12.4 years, 6M:6F). Children with rumination had significantly higher number of total reflux events (RE)/24 hrs, total number of proximal RE/24 hrs (p< 0.0001) and postprandial non-acid RE/hr (p=0.0072) compared to GERD and non-GERD groups. The SAP for regurgitation/reflux/vomiting was significantly higher in the rumination group (p=0.0009). The scoring system includes: 1)Total proximal RE/24hrs >57.5, 2)Postprandial non-acid RE/hr >2, 3)SAP for regurgitation/reflux/vomiting >97.5. Each parameter scores 1 and rumination is diagnosed if the score is < 2. We validated the scoring system in a group of 18 children who underwent both a HRM/Z and MII-pH (8 diagnosed with rumination - 3M:5F, median age: 13 years - and 10 with a negative HRM/Z - 4M:6F, median age:8.5 years). The sensitivity and specificity of the score is 75% and 80% respectively.
Conclusion: Children with rumination have many more symptomatic reflux episodes (SI/SAP positive) with high proximal extent, particularly during postprandial periods compared to GERD and controls. Our scoring system allows for early identification of children with rumination syndrome.
Disclosure: Nothing to disclose
Данная публикация — тезисы доклада (abstract) на 27-й Объединённой Европейской Гастроэнтерологической Неделе UEG Week 2019, г. Барселона.
Тезисы (abstracts) всех докладов UEG Week 2019 (pdf, 12,4 Mb): https://www.ueg.eu/publications/abstractbook
См. также: Параскевова А.В. Объединённая Европейская Гастроэнтерологическая Неделя 2019 (United European Gastroenterological Week 2019) // www.gastroscan.ru, 2019.
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