Vitamin D status in children with nasopharyngeal manifestations of gastroesophageal reflux disease

Abstract

The aim of the study is to estimate the peculiarities of vitamin D status in children with nasopharyngeal manifestations of gastroesophageal reflux disease to improve the prevention of chronic tonsillitis.

Materials and methods. Eighty-eight children with an average age of 4.60 ± 0.14 years were enrolled into the study. The patients were divided into three groups: group 1 (treatment group) comprised 22 people with gastroesophageal reflux disease (GERD) and chronic tonsillitis (CT); group 2 consisted of 22 people having CT without GERD, and group 3 included 22 children with GERD but without CT. The control group (group 4) included 22 children without gastrointestinal and ENT pathologies. There were no any significant sex differences among children from all the groups.

The analysis of vitamin D status in children was performed. The results were statistically processed by means of Microsoft Office Excel and Statistica 13 software.

Results. It has been found that vitamin D deficiency was common for all group 1 children, and 9 % of them had severe vitamin D deficiency (less than 10 ng/ml). Deficiency of vitamin D was observed in 86.4 % of group 2 children. Only 4.5 % of group 3 children demonstrated vitamin D deficiency, and insufficient level of vitamin D was revealed in 91.0 % of children. Vitamin D deficiency was not detected in the control group children, 86.4 % of whom demonstrated insufficient vitamin D level, and 13.6 % had sufficient vitamin D level. The average 25(OH)D3 level in the studied groups was significantly lower than in children from the control group, and that was lower in group 1 children than in children from other studied groups (P = 0.00001). Children with nasopharyngeal manifestations of GERD demonstrated lower levels of 25(OH)D3 than group 2 children (13.05 ± 0.55 compared to 17.91 ± 0.45, P = 0,00001). The study of 1.25(OH)2D level has confirmed that it was significantly higher in children of all the studied groups than that in the control group. The indicators of group 1 children were significantly higher (142.28 ± 6.99) than those of the control group children (46.38 ± 2.61, P = 0.00001) and children from other studied groups (76.63 ± 1.73 and 109.06 ± 4.68, P = 0.00001, respectively). It has been identified that there was a negative correlation between 25(OH)D3 and 1.25(OH)D2 levels (r = -0.52, P = 0.01). Positive correlation between these indicators (r = 0.63, P = 0.0016 and r = 0.66, P = 0.0009, respectively) was revealed in group 3 children. According to the results of vitamin D-binding protein level study, no significant differences were found both among the studied groups and the control group. Besides, no correlation was defined between levels of 25(ОН)D3 and vitamin D-binding protein, as well as between 1.25(OH)2D and vitamin D-binding protein, which is compatible with the literature data.

Conclusions. Patients with gastroesophageal reflux disease and chronic tonsillitis (groups 1–3) experienced a decreased level of vitamin D, which was associated with vitamin D undersaturation in the antenatal period. In addition, our results have shown that nearly 90 % of children experienced a deficiency in vitamin D as in the literature data. In 93 % of children with chronic tonsillitis, deficiency of vitamin D was observed regardless of the GERD presence. In children with GERD, a low level of vitamin D was determined comparing to the children of the control group. However, a lower level of 25(OH)D3 was reported in children with nasopharyngeal manifestations of GERD, which may indicate the impact of vitamin D deficiency on the development of this pathology.