Журнал «Здоровье ребенка» (62) 2015. Тематический выпуск "Детская гастроэнтерология"
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Risk factors of pathology of the upper gastrointestinal tract in children with asthma
Авторы: Bolbot Y.K., Kalichevskaya M.V. — SE "Dnipropetrovsk medical academy of Health Ministry of Ukraine"
Рубрики: Педиатрия/Неонатология
Разделы: Клинические исследования
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In recent years there has been a tendency to increase the incidence of bronchial asthma and its more severe course, despite the constant improvement of methods of diagnostics, treatment and prevention. One of the factors that may impede full control of symptoms, called the presence comorbidity pathology, including pathology of the digestive tract. Early detection of comorbidity in children with bronchial asthma and rational correction may improve control of symptoms, which, in turn, will reduce the need for funds basic anti-inflammatory therapy and drugs symptomatic actions.
Objective: to build a model for predicting the risk of diseases of the upper gastrointestinal tract in children with bronchial asthma.
Material and methods. The study included 120 children with bronchial asthma, including 78 identified concomitant diseases of upper gastrointestinal tract. Clinical and laboratory and instrumental studies were conducted to all children. On the base of the analysis of primary medical records (F-003/o) and stories of child development (F-112), data of ante-, peri- and postnatal periods and clinical manifestations of atopy and concomitant somatic pathology were retrospectively evaluated.
Statistical processing of the obtained results was performed using the methods of variation statistics and regression analysis implemented in the software package "STATISTICA 6.1".
Results. The average duration of asthma in children with concomitant of upper gastrointestinal tract diseases was (6,8 ± 0,46) years, while in children with asthma and no gastrointestinal tract pathology - (3,9 ± 0,48) years (p <0,05). In the presence of pathology gastrointestinal tract of bronchial asthma in children has more severe course and is accompanied by lower level of control over the symptoms. In presence of upper gastrointestinal tract pathology level of asthma control was lower. Full control of asthma on a background of basic therapy was observed in only 16,7% of children in group I, while group II children demonstrated it in 52,4% of cases (OR=5,5, RR=1,75, χ²=15 17, p=0,0007). Effect of severity of asthma on the incidence of gastrointestinal pathology was determined primarily by prolonged hormonal basic treatment, used by 82% of children in group I and 62% of children in group II (OR=2,8, RR=1,33, χ²=4,88, p=0,027). With increasing severity and duration of asthma, frequency and severity of lesions of the gastrointestinal mucosa increases either. The frequency of destructive mucosal lesions of gastrointestinal tract increases in children with asthma duration more than 3 years (OR=,65, RR=2,62, χ2=4,3, p=0,038), as well as with moderate and severe asthma (OR=13,84, RR=10,04, χ2=7,5, p=0,0071).
Persistence of H.pylori in children with bronchial asthma contributed to worsening of asthma control due to the increase in the number of hospitalizations for asthma exacerbation, in comparison to children with no H.pylori infection detected. Treatment of upper gastrointestinal tract pathology in asthmatic patients led to an increase in the number of children with full control over the asthma symptoms. Positive dynamics in asthma control noted, primarily due to a reduction in the frequency of daytime symptoms, night symptoms and reducing the additional use of short-acting β2-agonists.
The presented data demonstrate a negative impact of gastrointestinal tract comorbidities on the course of asthma in children and point to the need for its targeted detection and timely treatment.
On the base of the regression analysis, a set of risk factors for chronic gastroduodenal pathology in children with asthma was identified: sex, duration of the disease, severity and level of control of asthma symptoms, duration of breastfeeding, food allergy, H.pylori infection, the presence of gastrointestinal pathology in child’s parents. Several prediction models for risk of chronic diseases of the upper gastrointestinal tract (including destructive) in this group of patients were developed on the base of clinical and laboratory parameters.
The most practically convenient is the model using 2 indicators: the presence of H. pylori infection and food sensitization in a patient. The total number of cases of correct prediction for this model is 73,3%. The risk of developing of upper gastrointestinal tract pathology in children with bronchial asthma (Z) might be predicted using the following formula:
Z = - 0,389 + 20,977 • X1 + 0, 987 • X2,
where X1 is the presence of H. pylori infection in the patient (present - 1 point; absent - 0 points); X2 - the presence of sensitization to food allergens (present - 1 point; absent - 0 points), when the Z value is greater than 0.5. If the diagnosis of H. pylori infection is difficult or impossible, it makes sense to use an alternate adjusted prognostic model. The calculation formula for this model is as follows:
Z = – 1,481 + 0,191 • X1 + 0,231 • X2 - 0,076 • X3 + 1,303 • X4
where X1- duration of asthma (years); X2 - severity of bronchial asthma (intermittent - 1 point, mild persistent - 2 points, persistent moderate - 3 points, severe persistent - 4 points); X3 - level control of asthma (controlled - 1 point, partially controlled - 2 points, uncontrolled - 3 points); X4 - food sensitization (present - 1 point, absent - 0 points). For this model the number of correctly predicted positive results in the presence of upper gastrointestinal tract pathology in asthmatic children was 84.6%.
The risk of destructive mucosal lesions of gastrointestinal tract in children with bronchial asthma can be predicted in 74.4% of cases according to the formula: Z = – 4,649 + 1,043 • X1 + 1,277 • X2, where X1 is the severity of bronchial asthma (intermittent - 1 point, mild persistent - 2 points, persistent moderate - 3 points, severe persistent - 4 points); X2 - the presence of H. pylori infection in a patient (present - 1 point, absent - 0 points).
Predictive models presented have a sufficient level of sensitivity, easy to use and can be recommended for primary care physicians.
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