Shalamai M. Clinical-instrumental signs of the treatment efficiency of gastroesophagal reflux disease in children

Thesis is devoted to the solving of the actual task of the children's gastrology - increasing of the efficiency of diagnostic; pharmacological correction of the gastroesophagal reflux disease in children while studying clinical-laboratory, endoscopic peculiarities signs of the daily pH-metric of the gullet and morphological changes of its mucous membrane. At the background of 104 children's examination, in their count 80 with gastroesophagal reflux disease, at the age of 10 up to 17 years we estimated clinical-laboratory signs of the disease currency, established signs of the intragullet pH-monitoring in dependence on endoscopic variant of the GERD and morphological changes of the gullet mucous membrane. In 52,5% of the patients with GERD was estimated endoscopic-negative variant of the disease with prevalence of the heartburn syndrome. In 47,5% of the children with endoscopic-positive variant of GERD clinical signs manifested with acid belch (80,5%), lowering of the appetite (57,4%). Presence of the reflux duration point in case of рН<4,0 over 5 minutes indicates on possible risk of the severe clinical signs. Presence of the time duration of the intragullet exposure of the acid over 9,12 ± 0,98 is a high specific feature that indicates risk of the gullet mucous membrane change. Presence of the increased FAE (16,6 ± 3,51) and quantity of the reflux episodes (18,7 ± 4,90), that correlate with intragullet рН<7,2 should be a marker of the endoscopic-positive variant of the GERD with alkali reflux. In case of the morphological study we estimated that alkali refluxes caused more significant changes of the mucous membrane up to atrophic changes and desquamation of the upper cells, dystrophic changes of the husk layer of the epithelial cells, as well as dystrophic changes of the basal epithelial cells. Including to the complex therapy of the GERD of the prokinetic (mothylium) and against secretor drug (phospholugel) influenced regression of the clinical symptoms in 85% of the children after 10-days course of treatment, normalization of the daily pH-monitor of the gullet signs and liquidation of the endoscopic features of the disease after the treatment for the month in 89%.