Proposta de uma escala de gravidade do refluxo gastroesofágico em crianças e adolescentes não neuropatas

• Ano de defesa: 2014
• Autor(a) principal: Pereira, Edward Esteves
• Orientador(a): Costa, Paulo Sérgio Sucasas da
• Banca de defesa: Costa, Paulo Sérgio Sucasas da, Helman, Laura, Perez-Boscollo, Adriana Cartafina, Quireze Júnior, Claudemiro, Avelino, Mariza Martins
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Goiás
• Programa de Pós-Graduação: Programa de Pós-graduação em Ciências da Saúde (FM)
• Departamento: Faculdade de Medicina - FM (RG)
• País: Brasil
• Palavras-chave em Português: Refluxo gastroesofágico; Fundoplicatura; Esofagite; Crianças; Inibidor de bomba de prótons
• Palavras-chave em Inglês: Gastroesophageal reflux; Fundoplication; Esophagitis; Children; Pronton pump inhibitor
• Área do conhecimento CNPq: CIENCIAS DA SAUDE
• Link de acesso: http://repositorio.bc.ufg.br/tede/handle/tede/3896

Background: Children with gastroesophageal reflux disease (GERD) are a heterogeneous group of patients who receive their treatments, usually subjectively and with unexpected outcomes. The preferences for long-term medical or a unique surgical management have caused problems, because not all patients have the same degree of reflux, especially neurologically normal children (NNC). No pediatric classification or GERD severity scale has been reported so far. Objective: To develop a GERD severity scale in NNC and validate it in population of previously treated NNC. Patients and methods: A retrospective cross-sectional cohort study of NNC with GERD, up to the age of 18, admitted from May/1995 to May/2008. The charts data were reviewed for the statistical selection of 10 preoperative parameters related to GERD, to compose the Pediatric Gastroesophageal Reflux Scale (PEGERS). Each parameter received numerical values, proportional to its severity degree, whose sum in a patient resulted in his reflux severity score. After exclusion criteria, 399 patients were avaiable and received 409 treatment regimens (events for scoring). Besides medical treatment for mild cases, the patients had undergone partial anterior fundoplication (PFP, 270º) for estimated moderately severe GERD and total fundoplication (TFP, 360º) for estimated severe cases. To correlate the scores to the long-term results and validate the scale, the outcomes were compared according to GERD severity grades Results: The scores ranged from 3 to 26, forming 3 severity grades: low severity reflux (LS, scores ≤ 12, n=66), moderate (MS, 13-18, n=141) and high (HS, ≥ 19, n=202). Cases treated coincidentally to their optimal severity scores formed the i-PEGERS group (n=345). The others were treated off their ideal score, forming the o-PEGERS group. The i-PEGERS events had statistically more favorable rates than o-PEGERS concerning cure or improvement of GERD, postoperative complications, recurrences and quality of life. The PEGERS could evaluate the severity of all kinds of reflux. Conclusions: It is possible to apply a gastroesophageal reflux severity scale in NNC, which allows appropriate tailored treatments with the best chance for cure of GERD, few recurrences and better QOL than using subjective or unique treatment plans for all cases.