Duodenogastric reflux: clinical and therapeutic aspects
Adam Szarszewskia, Maria Korzona, Barbara Kamiñskaa, Piotr Lassb
a Department
of Paediatrics, Paediatric Gastroenterology and Oncology, Medical
University of Gdañsk, ul. Nowe Ogrody 1/6, 80-803 Gdañsk, Poland, b Department of Nuclear Medicine, Medical
University of Gdañsk
Correspondence to: Dr Szarszewski.
Accepted 11
September 1998
BACKGROUND
Duodenogastric
reflux is believed to cause damage to gastric mucosa. Most reports on
this disorder concern adult patients.
PATIENTS AND
METHODS1120 children with abdominal pain were
studied; endoscopic features of duodenogastric reflux were found in 92 patients. To confirm the diagnosis of duodenogastric reflux,
cholescintigraphy (Tc99-HEPIDA) was performed. Children with confirmed
duodenogastric reflux by scintigraphy were given a prokinetic drug (cisapride).
RESULTSEndoscopic
features of duodenogastric reflux were found in 92 children; the
diagnosis was confirmed by scintigraphy in 59 patients. There was no
significant difference in the severity of inflammation in gastric
mucosa compared with the control group, whereas significantly fewer of
these patients were infected with Helicobacter
pylori. There was no correlation between regions of isotope
accumulation and inflammatory lesions in the stomach. The prokinetic
drug (cisapride) helped eliminate or greatly reduce duodenogastric
reflux in children.
CONCLUSIONSWhen
endoscopic features of duodenogastric reflux are found the final
diagnosis should be based on an examination that does not itself
influence the motility of the gastrointestinal tract: cholescintigraphy
seems to be a useful method. However, because the use of milk as a test
meal affects the scintigraphic image, there was no correlation between
the area of isotope accumulation and the localisation of inflammatory
lesions in the stomach. Duodenogastric reflux seems to be less
important as a cause of inflammatory lesions than other factors (such
as genetic predisposition, stress, etc). Prokinetic drugs have a
beneficial influence on treatment results in children with inflammatory
lesions of gastric mucosa with duodenogastric reflux.
Keywords: duodenogastric reflux; cholescintigraphy; cisapride
© 1999 by Archives of Disease in Childhood
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