Purpose: Minimal change esophagitis (MCE) is a reflux disease without mucosal breaks, known to be partially associated with abnormal gastric motor function. Electrogastrography (EGG) is commonly applied to assess gastric motor function in a noninvasive fashion. We aimed to determine the relationship...
Purpose: Minimal change esophagitis (MCE) is a reflux disease without mucosal breaks, known to be partially associated with abnormal gastric motor function. Electrogastrography (EGG) is commonly applied to assess gastric motor function in a noninvasive fashion. We aimed to determine the relationship between MCE and gastric myoelectrical activity (GME) recorded on EGG in children. Methods: We retrospectively assessed the records of 157 children without underlying disease who underwent both EGG and upper gastrointestinal endoscopy at Gachon University Gil Medical Center between January 2010 and June 2015. The children were stratified according to the appearance of the esophagus (normal vs. MCE). Between-group differences in EGG parameters and their correlation with each MCE finding were statistically analyzed. Results: Only the power ratio, one of the EGG parameters analyzed, differed significantly between the two groups (MCE, $1.68{\pm}3.37$ vs. normal, $0.76{\pm}1.06$; p<0.05), whereas the other parameters, such as dominant frequency, dominant power, and the ratio of abnormal rhythm, showed no differences. Among children with MCE, significant correlations were noted between erythema and power ratio (p<0.05), friability and postprandial dominant frequency (p<0.05), and edema and/or accentuation of mucosal folds and pre-prandial frequency (p<0.05). Helicobacter pylori infection correlated with postprandial arrhythmia (MCE, $33.59{\pm}15.52$ vs. normal, $28.10{\pm}17.23$; p<0.05). EGG parameters did not differ between children with normal esophagus and those with biopsy-proven chronic esophagitis. Conclusion: In children with MCE, gastric dysmotility may affect the development of MCE, manifesting as EGG abnormalities. H. pylori infection may also affect GME. However, larger prospective investigations are needed to confirm these findings.
Purpose: Minimal change esophagitis (MCE) is a reflux disease without mucosal breaks, known to be partially associated with abnormal gastric motor function. Electrogastrography (EGG) is commonly applied to assess gastric motor function in a noninvasive fashion. We aimed to determine the relationship between MCE and gastric myoelectrical activity (GME) recorded on EGG in children. Methods: We retrospectively assessed the records of 157 children without underlying disease who underwent both EGG and upper gastrointestinal endoscopy at Gachon University Gil Medical Center between January 2010 and June 2015. The children were stratified according to the appearance of the esophagus (normal vs. MCE). Between-group differences in EGG parameters and their correlation with each MCE finding were statistically analyzed. Results: Only the power ratio, one of the EGG parameters analyzed, differed significantly between the two groups (MCE, $1.68{\pm}3.37$ vs. normal, $0.76{\pm}1.06$; p<0.05), whereas the other parameters, such as dominant frequency, dominant power, and the ratio of abnormal rhythm, showed no differences. Among children with MCE, significant correlations were noted between erythema and power ratio (p<0.05), friability and postprandial dominant frequency (p<0.05), and edema and/or accentuation of mucosal folds and pre-prandial frequency (p<0.05). Helicobacter pylori infection correlated with postprandial arrhythmia (MCE, $33.59{\pm}15.52$ vs. normal, $28.10{\pm}17.23$; p<0.05). EGG parameters did not differ between children with normal esophagus and those with biopsy-proven chronic esophagitis. Conclusion: In children with MCE, gastric dysmotility may affect the development of MCE, manifesting as EGG abnormalities. H. pylori infection may also affect GME. However, larger prospective investigations are needed to confirm these findings.
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문제 정의
Few studies have compared gastric motility between normal esophagus and MCE, especially in children. Therefore, the purpose of the present study was to investigate the potential differences in gastric motility between endoscopically normal esophagus and MCE in children with reflux symptoms, and to determine whether endoscopic MCE is associated with gastric dysmotilities.
가설 설정
In contrast, patients with MCE have non-erosive endoscopic lesions and rarely show symptoms. Second, the reliability of EGG parameters ought to be considered. As mentioned above, the diagnostic capability of EGG parameters has been controversial because of their dependence on the antrum-skin distance, as well as because of the scarcity of research on this topic [19].
제안 방법
The comparisons between groups employed the chi-square test or Fisher’s exact test for categorical variables, while Student’s t-test or the Mann-Whitney U-test were used for the comparison of continuous variables. Logistic regression analysis was used to estimate the correlation between each endoscopic finding of MCE and each EGG parameter. A p-value of ＜0.
The medical records were examined retrospectively to extract demographic characteristics including age, sex, weight, height, and body mass index. The nature and duration of the chief complaint were investigated, including abdominal pain or heartburn, vomiting and/or nausea, dyspepsia, and others.
To our knowledge, this was the first investigation to directly assess the correlation between endoscopic findings and EGG parameters, which represents the key strength of the present study. Nevertheless, some limitations of the present study should be noted.
대상 데이터
A retrospective study was conducted on 194 children (age ＜18 years) who underwent both EGG and upper gastrointestinal endoscopy at Gachon University Gil Medical Center between January 2010 and June 2015. Of these, 157 children were included in our study after excluding 37 children for the following reasons: diagnosis of other diseases (eosinophilic esophagitis diagnosed on biopsy, 6 patients; reflux esophagitis with Los Angeles grade A, 5 patients; testicular germ cell tumor, 1 patient; biliary pancreatitis, 1 patient), missing EGG data (16 children), and lack of endoscopic findings (8 children).
Of these, 157 children were included in our study after excluding 37 children for the following reasons: diagnosis of other diseases (eosinophilic esophagitis diagnosed on biopsy, 6 patients; reflux esophagitis with Los Angeles grade A, 5 patients; testicular germ cell tumor, 1 patient; biliary pancreatitis, 1 patient), missing EGG data (16 children), and lack of endoscopic findings (8 children). Of the 157 children included in the study, 153 children underwent tests to detect Helicobacter pylori infection.
Correlations were obtained using logistic regression analysis.
The comparisons between groups employed the chi-square test or Fisher’s exact test for categorical variables, while Student’s t-test or the Mann-Whitney U-test were used for the comparison of continuous variables.
성능/효과
Nevertheless, some limitations of the present study should be noted. First, the group of children with MCE was significantly larger than the group of children with normal esophagus, and the age distribution of the two groups was also significantly different. This limitation is associated with the retrospective, single-center design of our study.
pylori infection correlates with antral hypomotility in patients with non-ulcer dyspepsia [26]. In our study, there was significant correlation between H. pylori infection and the EGG parameter postprandial arrhythmia (p ＜0.05). However, there was no correlation between H.
Only the power ratio differed between children with normal esophagus and those with MCE (p=0.021), whereas other EGG parameters such as pre- and postprandial dominant frequency, dominant power, and percent of pre- or postprandial normogastria, tachygastria, or bradygastria did not differ between the groups (Table 2).
007). The Z-score was utilized to compare the groups in terms of weight, height, and body mass index, which could be affected by sex and age, and no significant between-group difference was found. Similarly, there were no significant between-group differences in chief complaint, symptoms and signs, or duration of symptoms (Table 1).
006). There was no significant association between other findings of MCE (blurring of the Z-line, decreased vascularity, white turbid discoloration) and other EGG parameters (preprandial dominant frequency; postprandial dominant frequency and power; normogastria, tachygastria, and bradygastria percentages of the preprandial and postprandial rhythm) (Table 3).
후속연구
Finally, there was no follow-up evaluation of children with MCE after treatment. Further in-depth studies with prospective design and larger sample size, and covering several age groups, are necessary. Specifically, a study on whether the severity of symptoms, recurrence, medication, or other medical conditions and evaluations are reflected in EGG parameters would be helpful.
pylori infection could be caused by gastric dysmotility without reflux disease. Nevertheless, a more in-depth study assessing the correlation between EGG parameters and H. pylori infection is needed.
참고문헌 (26)
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