Follow-up examinations of conservatively and surgically treated children with hiatus hernia

Determinants of gastroesophageal reflux disease in adults with a history of childhood gastroesophageal reflux disease

BACKGROUND & AIMS

We conducted a nested case-control study to examine the prevalence and risk factors for current gastroesophageal reflux disease (GERD) symptoms in young adults with a history of childhood GERD.

METHODS

We identified a cohort of individuals diagnosed with GERD in childhood during 1995-1996, and controls without childhood GERD. Patients with neurodevelopmental disorders, tracheoesophageal anomalies, or cystic fibrosis were excluded. A computer-assisted telephone interview was conducted during 2004-2005. We calculated the prevalence of GERD symptoms, and examined the potential determinants of symptoms in unadjusted and adjusted logistic regression analyses.

RESULTS

A total of 113 cases completed the questionnaires (participation rate, 70.6%). The mean age of participants was 18 years, and their mean age at the time of childhood GERD diagnosis was 10 years. At least weekly heartburn or regurgitation was reported in 52 (46%) participants, 94% of whom were taking proton pump inhibitors, H2RA, or antacids. On the other hand, 33 controls were identified (44% participation rate) in whom weekly heartburn or regurgitation was reported in 30%. GERD was significantly more frequent in females using oral contraceptive pills (76.5%) as compared with females not on oral contraceptive pills (47.9%), or males (33.3%) (P = .008). Weight, height, nonsteroidal anti-inflammatory drug use, race, family history of GERD, education level, employment status, tobacco smoking, alcohol, or coffee drinking were not associated significantly with adulthood GERD.

CONCLUSIONS

Frequent GERD symptoms requiring antisecretory therapy are present in approximately half of young adults with a history of childhood GERD. The use of oral contraceptives is a risk factor for GERD symptoms in these individuals.

Childhood GERD is a risk factor for GERD in adolescents and young adults

OBJECTIVE

The clinical course of gastroesophageal reflux disease (GERD) in children without comorbid illness (neurological deficits, congenital esophageal anomalies, chronic obstructive airway conditions) is unclear. Whether GERD in childhood progresses or predisposes to GERD in adulthood remains unknown.

METHODS

We identified a cohort of individuals endoscopically diagnosed with GERD in childhood between 1990 and 1996. We excluded patients with comorbid illnesses. Eligible persons were contacted by telephone in person or through a household member and requested to complete a validated (in adults) symptom questionnaire between February 2001 and February 2003. Respondents were invited to undergo an upper endoscopy or to share results of any endoscopic examination performed within the past 12 months. We calculated the proportion of persons with GERD symptoms (monthly, weekly), and with current use of antisecretory medications (histamine-2-receptor antagonists [H2RA], proton pump inhibitors [PPI]).

RESULTS

A total of 207 persons satisfied the inclusion and exclusion criteria and were contacted. Of those, 80 (39%) completed the questionnaire and 14/80 (18%) had an upper endoscopy. The mean age of participants was 20 years (SD = 4, range 10-40); most were Caucasian (73%), and 60% were female. GERD was documented at a mean age of 5 years (approximately a 15-yr duration of follow-up). Most participants (64/80, 80%) had at least monthly heartburn and/or acid regurgitation reported within the past 12 months; 18/80 (23%) reported at least weekly symptoms, and an additional three patients were asymptomatic but taking antisecretory therapy (H2RA or PPI). If all nonresponders were considered free of symptoms, then at least 31% had monthly symptoms, and 9% had weekly symptoms. Overall, 24 (30%) were currently taking either H2RA or PPI, and 19 patients had undergone fundoplication. There were no statistically significant differences between those who reported monthly GERD symptoms, weekly GERD symptoms, or no GERD symptoms as far as demographic features, age of GERD onset, receipt of fundoplication, or current GERD treatment. At endoscopy, three patients had mild to moderate erosive esophagitis.

CONCLUSIONS

GERD in otherwise normal children can persist through adolescence and adulthood in a significant proportion of patients who continue to have GERD symptoms and signs, and use antisecretory medications. Childhood GERD is a risk factor for GERD in adolescence and adulthood.

Hiatal hernia in pediatric gastroesophageal reflux

BACKGROUND

This study compares esophageal pH-monitoring parameters of children with gastroesophageal reflux (GER) with or without hiatal hernia (HH) and determines the outcome of those with GER and HH.

METHODS

Among 718 children with GER, 45 children (6%) with associated HH were retrospectively studied. They were divided into those with neurologically normal development (NN, n = 35) and those with neurologic disorders (ND, n = 10). The pH-monitoring parameters of 27 of these (60%) were compared with pH-monitoring parameters of 27 control children who had GER without HH.

RESULTS

Esophageal clearance was longer in patients with HH compared with those without HH (P < 0.05). All 35 NN patients underwent a trial of conservative treatment, which failed in 9 patients (25.7%). Surgery was the initial treatment in 8 ND patients. Follow-up was available in 20 NN and 10 ND patients. Nine of 11 conservatively treated NN patients improved. All NN (n = 9) and ND (n = 8) patients who underwent surgery improved. Conservative treatment failed in 2 NN and in 2 ND patients.

CONCLUSIONS

Presence of HH in children with GER is associated with prolonged exposure of the esophagus to acid and a high failure rate of nonoperative treatment. However, medical treatment should be tried in NN children despite the significant failure rate.