Gastroözefageal reflü hastalığı düşünülen çocuklarda özefagusun endoskopik bulguları ile histopatolojik sonuçları arasındaki  ilişkinin retrospektif analizi

GÜLNİHAN KIRBAŞ

Gastroözefageal reflü hastalığı düşünülen çocuklarda özefagusun endoskopik bulguları ile histopatolojik sonuçları arasındaki ilişkinin retrospektif analizi

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Ankara University, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Turkey

Approval Date: 2013

Thesis Language: Turkish

Student: GÜLNİHAN KIRBAŞ

Supervisor: Aydan Kansu Tanca

Open Archive Collection: AVESIS Open Access Collection

Abstract:

Aim: We aimed to investigate the frequency of reflux esophagitis (RE) in children with dyspeptic symptoms and symptoms suggestive of gastroesophageal reflux dısease (GERD) and to determine the relationship between symptoms and RE, the relationship between endoscopic and histopathological findings of oesophagus and relationship between Helicobakter pylori (Hp) infection and RE. Methods: We enrolled a total of 230 children between January 2008 and November 2009 with abdominal pain for at least 2 months accompanied with acid regurgitation, night cough, abdominal fullness, early satiety, nausea, vomiting, belching, halitosis, retrosternal pain, odynophagia and dysphagia. All patients underwent upper gastrointestinal endoscopy. Patients were divided into two groups according to their symptoms; suspected gastroesophageal reflux (GOR) group was defined as having acid regurgitation, night cough, halitosis, retrosternal pain, odynophagia and dysphagia and dyspepsia group was defined as having abdominal fulness, early satiety, nausea, vomiting, belching. Endoscopic findings were classified according to Los Angeles classification system. Histopathological reflux esophagitis was diagnosed based on the presence of papillar elongation, basal cell hyperplasia, elongation of stromal papilla, dilated intercellular space, cellular infiltration in mucosal and submucosal layers, the type of cells (eosinophils, neutrophils and mononuclear cells) vascular congestion, erosion and ulceration. Hp infection was considered positive if Hp was found positive in antrum biopsies. Erosive reflux disease (ERD) was defined as presence of mucosal damage (erosions or ulceration) by endoscopy and positive for histopathological findings. Nonerosive reflux disease (NERD) was defined as negative for endoscopic appearance but positive for histopathological findings. The paitents were defined as RE negative if histopathological findings were found negative. Results; We enrolled a total of 230 children with abdominal pain for at least 2 months, 137 of them were female (59.6%), 93 of them were male (40.4%) average age was 11.99 ± 3.37 years. 131 of them were in suspected GOR group (57%), 99 of them (43%) in dyspepsia group. 27 patients (11.7%) were positive for endoscopic appearance (24 of them in suspected GOR group, 3 of them in dyspepsia group). İn suspected GOR group, positive for endoscopic appearance was found statistically significant. The correlation between the heartburn and positive for endoscopic appearance in suspected GOR group were found statistically significant. İn dyspepsia group none of the complaints were found statistically significant with the endsocopic appearance. Histopathologic RE was diagnosed in 149 patients, 108 (82.4%) of them in suspected GOR group, 41 (41.4%) of them in dyspepsia group. Halitosis was found statistically significant in histopathological RE diagnosis in suspected GOR group. None of the complaints were found statistically significant with the histopathologic RE diagnosis in dyspepsia group. The patients in suspected GOR group and dyspepsia group were compared with histopathologic RE diagnosis; NERD was statistically significant in suspected GOR group and negative for histopathologic RE diagnosis was statistically significant in dyspepsia group. When histopathologic RE diagnosis was compared with endoscopic appearance; there was a statistically significant correlation between patients positive for endoscopic appearance and histopathologic RE positive diagnosis. The sensitivity, specifity, positive predictive value and negative predictive value were found 14.8%, 93.8%, 81.4%, 51.0%respectively for endoscopic diagnosis in determining histopathologic RE. 111 (48.3%) of the patients were positive for Hp. When histopathologic RE diagnosis was compared with Hp (+) and Hp (-) groups; there were no statistically significant difference between them. Conclusion; İn our study the frequency of RE was found 64.8%in children with dyspeptic symptoms and with symptoms suggestive of GERD. There were no statistically significant difference between symptoms and histopathologic RE diagnosis. The sensitivity, specifity, positive predictive value and negative predictive value were found 14.8%, 93.8%, 81.4%, 51.0% respectively for endoscopic diagnosis in determining histopathologic RE diagnosis. There were no statistically significant difference between Hp and histopathologic RE diagnosis. Collecting biopsy samples from oesophagus and histopathological evaluation seems the most suitable approach even in children with normal endoscopic appearance with dyspeptic symptoms and symptoms suggestive of GERD. Key Words: Gastroesophageal Reflux Disease, Dyspepsia, Non-erosive reflux disease, Erosive gastroesophageal reflux disease, Helicobacter pylori, endoscopic findings, histopathological findings.