The role of esophageal impedance in diagnosing children with poorly controlled asthma

Astma se može pojaviti u svakoj dobi, a najčešća je kronična bolest djece školske dobi. Brojne studije pokazuju stalan porast prevalencije i incidencije astme zadnjih 20-ak godina, a sličan se trend očekuje i u budućnosti. Astma je kronična upalna bolest donjih dišnih putova obilježena napadajima reverzibilne bronhoopstrukcije. U djece s loše kontroliranom astmom često nalazimo komorbiditete, od kojih je jedan od najvažnijih gastroezofagealna refluksna bolest (GERB). Prevalencija GERB-a u razvijenim zemljama dosegla je gotovo epidemijske razmjere. Gastroezofagealni refluks (GER) je nevoljno vraćanje želučanog sadržaja u jednjak. Ako agresivni činitelji tijekom GER-a nadvladaju obrambene mehanizme zaštite i uzrokuju oštećenje sluznice jednjaka i/ili simptome bolesti, riječ je o GERB-u. Multikanalna intraluminalna impedancija (MII) jednjaka je novija metoda koja se koristi za potvrdu GERB-a, posebno u bolesnika s refraktornim simptomima, za procjenu učinka antirefluksne terapije, te u dijagnostici alkalnog refluksa. Brojni su dokazi da liječenje GERB-a u bolesnika s astmom poboljšava simptome astme te smanjuje i skraćuje primjenu protuupalnih lijekova i bronhodilatatora u astmi. Obrada često asimptomatskoga GERB-a u djece s loše kontroliranom astmom, pa čak i s drugim kroničnim bolestima dišnog sustava, često je potrebna zbog njihove očite povezanosti. Diplomski rad opisuje važnost MII-a jednjaka kao nove metode u dijagnostici GERB-a u djece s loše kontroliranom astmom, te objašnjava povezanost GERB-a i astme u djece koristeći se dostupnom znanstvenom literaturom i publikacijama.Asthma may occur at any age and is the most common chronic disease of children. Numerous studies have shown a steady increase in the prevalence and incidence of asthma, and a similar trend is expected in the future. Asthma is a multifactorial caused disease. It is a chronic inflammatory disease of the bronchi characterized by reversible attacks of wheezing. In children with poorly controlled asthma, comorbidities are often present, especially GERD. Gastroesophageal reflux (GER) is the involuntary return of gastric content into the esophagus. GERD in developed countries has reached almost epidemic proportions, while in the poor countries is present in a smaller extent. If aggressive factors during GER overcome the defense mechanisms of protection and cause damage to the lining of the esophagus and/or cause symptoms of the disease, it is called gastroezophageus reflux disease (GERD) and it must be treated. Multi-channel intraluminal impedance (MII) of the esophagus is a newer method that is useful to confirm reflux disease, especially in cases of patients with refractory symptoms, to confirm the adequacy of antisecretory therapy, and to determine the presence of alkaline reflux . Numerous clinical trials confirm that the treatment of reflux disease improves symptoms of asthma and also to minimizes and reduces the need for medications. The examination, in often asymptomatic GERD in children with poorly controlled asthma, and even with other respiratory diseases, is essential because of their obvious connection. Diploma thesis describes the importance of the impedance of the esophagus as a new method in the diagnosis of GERD in children with poorly controlled asthma, and connection between GERD and asthma, using the available literature from scientific articles