[Pulmonary gammagraphy study in asthmatic children with gastroesophageal reflux].

BACKGROUND

The asthmatic children who do not respond favorably to the specifically anti-allergic treatment, and also begin their breathlessness crisis preferably at night, are suspicious of suffering gastric-esophagus reflux that stimulate bronchial spasm crisis by means of an aspiration mechanism, or more frequently, by means of a reflective mechanism through the vagal via.

OBJECTIVES

To know probable physiopathologic mechanism of gastric-esophagus reflux that exacerbates asthmatic crisis. To know digestive symptoms associated to respiratory process. To evaluate clinic evolution of children after antireflux treatment.

MATERIAL AND

METHODS

There were chosen 50 moderate-severe persistent asthmatic patients with non favorable evolution and gastric-esophagus reflux. The diagnosis was settled by means of radiological study, with barium contrast in esophagus, stomach and duodenum, and esophagus-pulmonary gammagraphy with technetium 99 (99mTc). Besides, a searching of bronchial aspiration signs with the isotopic exploration was carried out.

RESULTS

It was demonstrated that 38% of all cases had bronchial microaspirations and 30% did not have digestive symptoms associated to the respiratory process. Patients were subjected to an antireflux treatment and 78% of them considerably improved their asthmatic crisis after the treatment.

CONCLUSIONS

38% of the cases showed bronchial microaspirations in pulmonary gammagraphy. The more probable physiopathologic mechanism was vagal via, because 62% of the patients did not have bronchial aspiration signs. There were no digestive symptoms (silent reflux) in 30% of the children. Asthmatic crisis evolved favorably in 78% of the cases after antireflux treatment.