Cough reflex sensitivity in children with suspected and confirmed gastroesophageal reflux disease.

Experimental and clinical studies performed in adults revealed that gastresophageal reflux disease (GORD) is associated with an appreciable increase in cough reflex sensitivity (CRS). The association between respiratory diseases and GORD is also present in children, but there is little evidence that GORD without aspiration of refluxate (proximal reflux) is a frequent cause of cough in children. The aim of this study was to find out whether CRS in children with GORD will be changed compared with healthy children, and if so, to determine the role of proximal vs. distal reflux in these changes. CRS and 24-h esophageal pH monitoring were performed in 20 children of whom 13 had confirmed GORD and 7 were suspected to have GORD. The control group consisted of 27 healthy children. For assessing the CRS, each subject inhaled 12 capsaicin aerosol concentrations (0.61-1250 micromol/l) at 1 min intervals. CRS was defined as the lowest capsaicin concentration that evoked minimally 2 coughs (C2). CRS in the group of children with suspected GORD [C2: 17.0 micromol/l (6.4-45.6 micromol/l)] and with confirmed GORD [C2: 13.4 micromol/l (3.6-50.9 micromol/l)] were significantly elevated (P<0.05) compared with healthy children [C2: 72.1 micromol/l (25.5-203.9 micromol/l)]. According to the parameters of 24-h pH monitoring, a significantly higher exposure to acid was present in the distal compared with proximal oesophagus. CRS changes correlated negatively with the distal, but not proximal, esophageal acid exposure. In conclusion, CRS changes in children suffering from GORD are similar to those described in adult patients with GORD. It is plausible that the main role in increased CRS in children with GORD play episodes of distal acid refluxes.

[Psychotherapy in the treatment of encopresis in children with idiopathic megacolon]. / Psychoterapia v liecbe enkoprézy u detí s idiopatickým megakolonom.

The authors treated by psychotherapy 70 children aged 3 to 15 years with encopresis and constipation. In all irrigographic examination revealed idiopathic megacolon. In the course of treatment and after treatment 93.1% of the children are free from complaints, of these 48% are without any treatment, the others are given intermitently small doses of lactulose and Clavigrenin. 4.6% of children have occasional problems, 2.3% of the patients did not improve. Improvement of the condition depends on the cooperation of the parents, in particular the mothers. In mothers of the treated children by means of Knobloch's test a higher score of neuroticism was found, as compared with mothers of children with common infections.

[Radionuclide scintigraphy in the diagnosis of Meckel's diverticulum]. / Vyuzitie rádionuklidovej scintigrafie pri diagnostike Meckelovho divertiklu.

In the submitted case-history the authors draw attention to the advantage of radionuclide diagnosis of ectopic gastric mucosae located in Meckel's diverticula. Diagnosis with 99mTc is according to the authors the treatment of choice in acute haemorrhage into the GIT with an obscure aetiology.