Biochemical Manifestations of Gastroesophageal Reflux Disease Progression in Children: A Single Center Case-Control Study
Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations o...
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Published in: | Applied sciences Vol. 10; no. 12; p. 4368 |
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Abstract | Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations or markers of complications. The aim of our paper was to evaluate biochemical parameters secondary to GERD in children. Two hundred and sixty-seven children of both genders aged between 1 month and 18 years who displayed suggestive symptoms for this condition were included in the study and were monitored for a period of 5 years. Depending on the range of symptoms and technical possibilities, the following procedures/investigations were performed: esophageal pH monitoring and imagistic or endoscopic examination, besides specific biochemical investigations. The cohort was sub-divided into two groups: one that included 213 children with confirmed GERD who represented the study group and 54 healthy children where GERD had been excluded, the control group. Out of all the investigated children, 39.0% displayed low hemoglobin values, 43.7% displayed low values of erythrocyte indices (MCH), and 68.5% had increased erythrocyte sedimentation rate (ESR) values, while increased eosinophil levels were recorded in 46.9% of the cases. Such parameters were proven to be a biomarker of suspected eosinophilic esophagitis, whereas 32.9% of the cases displayed high blood glucose values that could be correlated with gastroesophageal reflux symptoms. Other measured parameters (such as magnesium, aminotransferases and proteins) remained within the normal limits, without statistically significant differences compared to in the control group. This condition is diagnosed based on invasive investigations, which are often difficult to accept by the patients’ parents. The biochemical modifications correlated to the clinical manifestations can anticipate the progression of the disease, thus limiting the necessity of performing invasive diagnosis tests. |
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AbstractList | Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations or markers of complications. The aim of our paper was to evaluate biochemical parameters secondary to GERD in children. Two hundred and sixty-seven children of both genders aged between 1 month and 18 years who displayed suggestive symptoms for this condition were included in the study and were monitored for a period of 5 years. Depending on the range of symptoms and technical possibilities, the following procedures/investigations were performed: esophageal pH monitoring and imagistic or endoscopic examination, besides specific biochemical investigations. The cohort was sub-divided into two groups: one that included 213 children with confirmed GERD who represented the study group and 54 healthy children where GERD had been excluded, the control group. Out of all the investigated children, 39.0% displayed low hemoglobin values, 43.7% displayed low values of erythrocyte indices (MCH), and 68.5% had increased erythrocyte sedimentation rate (ESR) values, while increased eosinophil levels were recorded in 46.9% of the cases. Such parameters were proven to be a biomarker of suspected eosinophilic esophagitis, whereas 32.9% of the cases displayed high blood glucose values that could be correlated with gastroesophageal reflux symptoms. Other measured parameters (such as magnesium, aminotransferases and proteins) remained within the normal limits, without statistically significant differences compared to in the control group. This condition is diagnosed based on invasive investigations, which are often difficult to accept by the patients’ parents. The biochemical modifications correlated to the clinical manifestations can anticipate the progression of the disease, thus limiting the necessity of performing invasive diagnosis tests. Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations or markers of complications. The aim of our paper was to evaluate biochemical parameters secondary to GERD in children. Two hundred and sixty-seven children of both genders aged between 1 month and 18 years who displayed suggestive symptoms for this condition were included in the study and were monitored for a period of 5 years. Depending on the range of symptoms and technical possibilities, the following procedures/investigations were performed: esophageal pH monitoring and imagistic or endoscopic examination, besides specific biochemical investigations. The cohort was sub-divided into two groups: one that included 213 children with confirmed GERD who represented the study group and 54 healthy children where GERD had been excluded, the control group. Out of all the investigated children, 39.0% displayed low hemoglobin values, 43.7% displayed low values of erythrocyte indices (MCH), and 68.5% had increased erythrocyte sedimentation rate (ESR) values, while increased eosinophil levels were recorded in 46.9% of the cases. Such parameters were proven to be a biomarker of suspected eosinophilic esophagitis, whereas 32.9% of the cases displayed high blood glucose values that could be correlated with gastroesophageal reflux symptoms. Other measured parameters (such as magnesium, aminotransferases and proteins) remained within the normal limits, without statistically significant differences compared to in the control group. This condition is diagnosed based on invasive investigations, which are often difficult to accept by the patients' parents. The biochemical modifications correlated to the clinical manifestations can anticipate the progression of the disease, thus limiting the necessity of performing invasive diagnosis tests. Keywords: gastroesophageal reflux disease; children; biochemical modifications |
Audience | Academic |
Author | Ghiga, Gabriela Balan, Gheorghe G Rosu, Oana Maria Timofte, Daniel Vasile Poroch, Vladimir Diaconescu, Smaranda Gimiga, Nicoleta |
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Cites_doi | 10.1023/A:1020540916482 10.1111/j.1365-2036.2004.02219.x 10.1097/MD.0000000000002539 10.1038/nrgastro.2009.45 10.1097/MPG.0b013e3181b7f563 10.1371/journal.pone.0178815 10.1542/peds.2013-0421 10.1097/MPG.0000000000001889 10.1016/j.ijporl.2013.08.014 10.37358/RC.17.11.5932 10.1002/j.1536-4801.2004.tb00871.x 10.18662/po/2016.0702.09 10.1016/j.atherosclerosis.2018.06.308 10.1007/s13312-013-0036-x 10.37358/RC.17.4.5545 10.18662/po/30 10.1053/j.sempedsurg.2017.02.007 |
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References | Esposito (ref_21) 2004; 38 Slater (ref_6) 2017; 26 Sevencan (ref_23) 2019; 11 Gurau (ref_28) 2016; 67 ref_11 Doros (ref_9) 2017; 68 ref_30 Nielsen (ref_19) 2004; 39 Poroch (ref_15) 2018; 9 Rosen (ref_1) 2018; 66 Toader (ref_12) 2012; 10 ref_17 Coman (ref_22) 2018; 275 Delaney (ref_3) 2004; 20 Toader (ref_10) 2018; 26 Toader (ref_13) 2010; 8 Hussain (ref_4) 2011; 17 Jugulete (ref_8) 2017; 68 Abdall (ref_25) 2013; 77 Diaconescu (ref_31) 2016; 95 Vandenplas (ref_2) 2009; 49 Corodeanu (ref_14) 2016; 7 Wu (ref_27) 2015; 40 Atkins (ref_24) 2009; 6 Olteanu (ref_5) 2015; 19 Janiszewska (ref_29) 2003; 7 Lightdale (ref_16) 2013; 131 Yukselen (ref_20) 2016; 58 Poddar (ref_26) 2013; 50 Tahmasebi (ref_7) 2017; 28 Khatib (ref_18) 2002; 47 |
References_xml | – volume: 8 start-page: 157 year: 2010 ident: ref_13 article-title: Ethics in medical technology education publication-title: Rev. Romana Bioet. contributor: fullname: Toader – volume: 47 start-page: 2596 year: 2002 ident: ref_18 article-title: Iron deficiency anemia: Induced by long-term ingestion of omeprazole publication-title: Dig. Dis. Sci. doi: 10.1023/A:1020540916482 contributor: fullname: Khatib – volume: 20 start-page: 2 year: 2004 ident: ref_3 article-title: Review article: Prevalence and epidemiology of gastro-oesophageal reflux disease publication-title: Aliment. Pharmacol. Ther. doi: 10.1111/j.1365-2036.2004.02219.x contributor: fullname: Delaney – volume: 17 start-page: 717 year: 2011 ident: ref_4 article-title: Recent advances in pediatric gastroesophageal reflux disease publication-title: Int. J. Med. Biol. Front. contributor: fullname: Hussain – volume: 95 start-page: e2539 year: 2016 ident: ref_31 article-title: Unusual endoscopic findings in children: Esophageal and gastric polyps. Three cases report publication-title: Medicine doi: 10.1097/MD.0000000000002539 contributor: fullname: Diaconescu – volume: 67 start-page: 190 year: 2016 ident: ref_28 article-title: The electrophoretic patterns of serum proteins in children publication-title: Rev. Chim. contributor: fullname: Gurau – ident: ref_11 – volume: 6 start-page: 267 year: 2009 ident: ref_24 article-title: Eosinophilic esophagitis: The newest esophageal inflammatory disease publication-title: Nat. Clin. Pract. Gastroenterol. Hepatol. doi: 10.1038/nrgastro.2009.45 contributor: fullname: Atkins – volume: 26 start-page: 429 year: 2018 ident: ref_10 article-title: Preventing malpractice and medical litigation in digestive interventional endoscopy by the use of empirical models for the informed consent publication-title: Rom. J. Leg. Med. contributor: fullname: Toader – volume: 49 start-page: 498 year: 2009 ident: ref_2 article-title: Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) publication-title: J. Pediatr. Gastroenterol. Nutr. doi: 10.1097/MPG.0b013e3181b7f563 contributor: fullname: Vandenplas – volume: 7 start-page: 211 year: 2003 ident: ref_29 article-title: IgE-dependent allergy—The intensification factor of gastroesophageal reflux in children and youth publication-title: Med. Wieku Rozw. contributor: fullname: Janiszewska – ident: ref_30 doi: 10.1371/journal.pone.0178815 – volume: 131 start-page: e1684 year: 2013 ident: ref_16 article-title: Section on gastroenterology, hepatology, and nutrition gastroesophageal reflux: Management guidance for the pediatrician publication-title: Pediatrics doi: 10.1542/peds.2013-0421 contributor: fullname: Lightdale – volume: 66 start-page: 516 year: 2018 ident: ref_1 article-title: Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition publication-title: J. Pediatr. Gastroenterol. Nutr. doi: 10.1097/MPG.0000000000001889 contributor: fullname: Rosen – volume: 77 start-page: 1765 year: 2013 ident: ref_25 article-title: Clinical evaluation of pepsin for laryngopharyngeal reflux in children with otitis media with effusion publication-title: Int. J. Pediatr. Otorhinolaryngol. doi: 10.1016/j.ijporl.2013.08.014 contributor: fullname: Abdall – volume: 19 start-page: 289 year: 2015 ident: ref_5 article-title: Effects of proton pump inhibitors on dental erosions caused by gastroesophageal reflux disease publication-title: Int. J. Med. Dent. contributor: fullname: Olteanu – volume: 11 start-page: 3176 year: 2019 ident: ref_23 article-title: Mean platelet volume and red cell distribution width as potential new biomarkers in children with gastroesophageal reflux disease publication-title: Am. J. Transl. Res. contributor: fullname: Sevencan – volume: 68 start-page: 2578 year: 2017 ident: ref_8 article-title: Biochemical modifications in HIV-infected children and adolescents under antiretroviral therapy publication-title: Rev. Chim. doi: 10.37358/RC.17.11.5932 contributor: fullname: Jugulete – volume: 40 start-page: 28 year: 2015 ident: ref_27 article-title: Gastroesophageal reflux disease management in pediatric patients publication-title: US Pharm. contributor: fullname: Wu – volume: 39 start-page: 383 year: 2004 ident: ref_19 article-title: Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: Disease association and evaluation of a new challenge procedure publication-title: J. Pediatr. Gastroenterol. Nutr. doi: 10.1002/j.1536-4801.2004.tb00871.x contributor: fullname: Nielsen – volume: 10 start-page: 66 year: 2012 ident: ref_12 article-title: Ethical and constitutional values reflected in medical law publication-title: Rev. Romana Bioet. contributor: fullname: Toader – volume: 7 start-page: 137 year: 2016 ident: ref_14 article-title: Ethical audit practice in hospital units—The pillar of the third generation of ethics publication-title: Postmod. Open. doi: 10.18662/po/2016.0702.09 contributor: fullname: Corodeanu – volume: 275 start-page: e110 year: 2018 ident: ref_22 article-title: Some inflammatory markers in metabolic syndrome-role of eosinophils publication-title: Atherosclerosis doi: 10.1016/j.atherosclerosis.2018.06.308 contributor: fullname: Coman – volume: 50 start-page: 119 year: 2013 ident: ref_26 article-title: Diagnosis and management of gastroesophageal reflux disease (GERD): An Indian perspective publication-title: Indian Pediatr. doi: 10.1007/s13312-013-0036-x contributor: fullname: Poddar – volume: 38 start-page: 452 year: 2004 ident: ref_21 article-title: Long-term follow-up of symptoms and peripheral eosinophil counts in seven children with eosinophilic esophagitis publication-title: J. Pediatr. Gastroenterol. Nutr. contributor: fullname: Esposito – volume: 28 start-page: 43 year: 2017 ident: ref_7 article-title: Pediatric reference intervals for biochemical markers publication-title: JIFCC contributor: fullname: Tahmasebi – volume: 68 start-page: 748 year: 2017 ident: ref_9 article-title: Relevance of the cardiac biomarkers in children with heart disease admitted for severe cardiac pathology publication-title: Rev. Chim. doi: 10.37358/RC.17.4.5545 contributor: fullname: Doros – volume: 9 start-page: 225 year: 2018 ident: ref_15 article-title: A possible diagnostic of the state of health of ethics management in the hospitals in Romania—An exploratory study publication-title: Postmod. Open. doi: 10.18662/po/30 contributor: fullname: Poroch – volume: 58 start-page: 254 year: 2016 ident: ref_20 article-title: Food allergy in children with refractory gastroesophageal reflux disease publication-title: Pediatr. Int. Off. J. Jpn. Pediatr. Soc. contributor: fullname: Yukselen – ident: ref_17 – volume: 26 start-page: 56 year: 2017 ident: ref_6 article-title: Gastroesophageal reflux publication-title: Semin. Pediatr. Surg. doi: 10.1053/j.sempedsurg.2017.02.007 contributor: fullname: Slater |
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SubjectTerms | Age biochemical modifications Biochemical toxicology Biochemistry Biomarkers Blood tests Case studies Children Children & youth Complications Development and progression Diagnosis Disease Disease control Endoscopy Erythrocyte sedimentation rate Erythrocytes Esophagitis Esophagus Gastroenterology Gastroesophageal reflux gastroesophageal reflux disease Hematology Hemoglobin Hepatology Hyperglycemia Laboratories Leukocytes (eosinophilic) Magnesium Pediatrics Physical examinations Signs and symptoms Statistical analysis Values |
Title | Biochemical Manifestations of Gastroesophageal Reflux Disease Progression in Children: A Single Center Case-Control Study |
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