Cystic fibrosis: a surgical matter?
BACKGROUND
Gastroesophageal reflux disease (GERD) is very common in patients with chronic lung diseases. We evaluated the incidence of GERD in young patients with cystic fibrosis (CF) and defined the characteristics of gastroesophageal reflux episodes analyzed by pH-multichannel intraluminal impedance (pH-MII) and esophagogastric scintigraphy.


METHODS
Since 2010, 31 patients with CF underwent pH-MII. Scintigraphy and upper endoscopy were performed in positive GERD patients. Forced expiratory volume in 1 second (FEV1%) predicted was detected.


RESULTS
pH-MII was positive in 17/31 (54.8%) patients (mean age: 12.4 years; range: 4-17 years). pH monitoring detected an average of 64.6 acid reflux events 4.4 episodes >5 minutes in duration. The DeMeester score was 38.5. Impedance identified a mean number of reflux episodes of 66 (65.2% acid; 32% weakly acidic; 2.8% nonacidic), 28% of which reached the proximal esophagus. Esophageal transit and gastric emptying were delayed in 6/13 (46.1%) and in 5/15 (33.3%) cases, respectively. No differences were found in lung function between positive and negative GERD patients (P=0.88).


CONCLUSIONS
Pediatric patients with CF have a high incidence of GERD with acidic events. These patients should be investigated with pH-MII and scintigraphy in order to make an early diagnosis and determine the most appropriate follow-up.
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: tamara.caldaro@opbg.net.
Tamara
T
Caldaro
Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Federico
F
Alghisi
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Paola
P
De Angelis
Nuclear Medicine Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Maria Carmen
MC
Garganese
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Francesca
F
Rea
Nuclear Medicine Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Milena
M
Pizzoferro
Nuclear Medicine Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Maria Felicia
MF
Villani
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Erminia Francesca
EF
Romeo
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Filippo
F
Torroni
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Francesca
F
Foschia
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Rosa Alba
RA
Gambitta
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Giovanni
G
Federici
Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Vincenzina
V
Lucidi
Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
Luigi
L
Dall'Oglio
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology; D016099:Endoscopy, Gastrointestinal; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D011877:Radionuclide Imaging; D013270:Stomach / Q000000981:diagnostic imaging / Q000503:physiopathology
Cystic fibrosis; Fundoplication; GERD; Gastric scintigraphy; pH-multichannel intraluminal impedance