新生児・乳児におけるGastroesophageal Reflux の診断的検討 : とくに上部・下部食道2点同時pH測定を中心として

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Gastroesophageal Reflux (GER) has been incriminated as a cause of respiratory symptoms and Sudden Infant Death Syndrome (SIDS) in newborns and infants. Upper G.I. series, esophageal manometric studys, and distal esophageal pH monitoring have been used to assess the significance of GER. However, these methods gave only slight informations regarding the diagnosis of GER to the upper portion of the esophagus. In the present investigation, upper and distal esophageal pH monitoring was done in newborns and infants. Nienteen patients with asymptomatic GER, and ten patients GER with respiratory symptoms or near miss SIDS were evaluated in this study. 1) From the results of two-points pH monitoring, GER was assumed to be present in cases with pH score above 8 points in the distal esophagus and 6 points in the upper esophagus. 2) Distal esophageal pH monitoring is one of the most useful methods in diagnosis of GER. 3) GER to the upper esophagus which causes respiratory symptoms and SIDS was presumed by distal esophageal pH monitoring to some extent. Direct upper esophageal pH monitoring, however, was more valuable to assess the GER up to the upper esophagus. 4) Seventeen patients with GER alone were treated concervatively by general management. And seven patients with respirator respiratory symptoms or near miss SIDS were treated conservatively also, but with intravenous hyperalimentation (IVH). All of them had good clinical results and GER disappeared after these therapy.