Review of the persistence of gastroesophageal reflux disease in children, adolescents and adults: does gastroesophageal reflux disease in adults sometimes begin in childhood?

Significance of Extra-Esophageal Symptoms in Pediatric Gastroesophageal Reflux Disease

Introduction  Current practice guidelines in gastroesophageal reflux disease (GERD) often require invasive diagnostic testing.

Objective  The aim of the present study was to evaluate the significance of extra-esophageal symptoms and reliability of a screening risk score that is simple to use.

Methods  A longitudinal retrospective single-institution cohort study. Setting: A university clinical hospital tertiary referral center. The present study enrolled pediatric patients with symptoms suggestive of GERD: epigastric pain, occasional nausea, regurgitation, tasting acid in the oral cavity, chronic cough, hoarseness of voice, frequent throat clearing. The patients underwent 24-hour esophageal pH monitoring and fiber-optic laryngoscopy. The correlations between the local findings, anamnestic and objective measurement data were analyzed.

Results  The present study evaluated 89 pediatric patients. Patients with asthma presented significantly more often with adjoining gastrointestinal symptoms ( p  = 0.0472). Patients that were obese were linked to a higher rate of reports of gastrointestinal symptoms ( p  = 0.0495). After the patients had been assigned to newly developed risk groups, obesity showed to be significantly more frequent in patients placed in higher risk groups ( p  < 0.0001) for a positive GERD diagnosis.

Conclusion  Patients with leading symptoms of asthma presented significantly more often with adjoining gastrointestinal symptoms. Obesity showed to be significantly more frequent in patients placed in higher risk groups for a positive GERD diagnosis.

Gastro-Esophageal Reflux in Children

Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

Clinical features and diagnostic reliability in paediatric laryngopharyngeal reflux

OBJECTIVE

The aim of this study was to assess the validity of current diagnostic approaches in pediatric laryngopharyngeal reflux (PLPR). Clinical status findings and 24h double probe oesophageal pH monitoring results in children with suspected PLPR and/or GERD were analyzed and a clinically useful probability score was developed.

METHODS

This is a retrospective longitudinal cohort study including 89 pediatric patients who underwent preliminary oropharyngoscopy, and then nasal fibre optic laryngoscopy and ambulatory 24h oesophageal pH monitoring in a tertiary pediatric and otorhinolaryngology hospital center. The patients' parents gave written informed consent for diagnostic testing. Statistical analysis was performed using standard descriptive statistics. Associations between variables were assessed using Fisher's exact test, Mann-Whitney test and Kruskal-Wallis test for non-parametric paired samples.

RESULTS

Patients' age spanned 1-18 years with a median of 11.2. Out of the 89 patients, 56 were girls, and 33 were boys. All of the patients underwent nasal fibre optic laryngoscopy and 24h double probe pH monitoring. Out of 89 examined children, 50 had PLPR. Out of the 50 positive for PLPR, 46 had a positive clinical finding, with a sensitivity of 92% (95% CI: 80.75-97.73%) and specificity of 10.26% (95% CI: 2.93-24.24%). Boys have GERD significantly more often than girls (p<0.0001), and have a worse result of pH monitoring (p<0.0001). The most common finding was an injected and granulated oropharynx accompanied by posterior laryngitis (54/89). Patients with leading symptoms of asthma had significantly worse GERD scores (p=0.0493). The patients were then reassigned to newly developed risk categories and a significant correlation with a positive PLPR diagnosis was found (p=0.0262).

CONCLUSIONS

The significance of a thorough otorhinolaryngologic and paediatric examination and patient history taking is still paramount, with additional benefit in diagnosing the disease arising from 24h oesophageal pH monitoring in select patients. This study brings to light new relationships between clinical symptoms and objective findings and presents a novel attempt to classify the likelihood of diagnosis. Patient stratification could help clinicians in defining groups at high risk and support a timely, cost-effective and precise diagnostic evaluation and proper therapy.

Risk of oesophageal adenocarcinoma among individuals born preterm or small for gestational age

BACKGROUND

Gastroesophageal reflux is a main risk factor for oesophageal adenocarcinoma (EAC). Infants born preterm or small for gestational age (SGA) regurgitate more than infants born at term, and some data support the hypothesis of an association with oesophagitis, Barrett's oesophagus and EAC. This study aimed to assess the association between risk of EAC and preterm or SGA birth.

METHODS

In this population-based case-control study, all incident cases of EAC in Sweden between 1st January 1998 and 31st December 2004 with retrievable birth records were eligible as cases. We sampled three matched controls per case from the birth ledger at the same delivery ward as the respective case. Data on gestational age, birth weight and other perinatal exposures were extracted from the original birth records. For comparison, we collected perinatal data for cases of cardia adenocarcinoma and oesophageal squamous cell carcinoma and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

The risk of EAC increased by 13% per week of shorter duration of gestation (OR 1.1, 95%CI 1.0-1.3), while SGA did not influence the risk. No effect of preterm birth or SGA was found on the risk of cardia adenocarcinoma or oesophageal squamous cell carcinoma.

CONCLUSION

Preterm birth, but not SGA, might lead to an increased risk of EAC as an adult.

Gastro-esophageal reflux disease in healthy older children and adolescents

Gastro-esophageal reflux disease (GERD) in otherwise healthy older children and adolescents is commonly encountered in pediatric clinics and poses a complex treatment problem involving changes of diets and lifestyle. After an initial history taking and a physical examination, typical symptoms of GERD in older children and adolescenct are initially treated with the trials of acid suppressants. With an increase of severe cases, more and more GERD children have been evaluated with endoscopy, which helps to delineate an erosive esophagitis from a non-erosive reflux disease as they are presumed to have different pathogenesis. For the pediatric patients without a significant underlying disease, a reflux esophagitis can be treated adequately with acid suppressants. Recently, the rapid increase of children who are taking anti-reflux medication has brought up a serious alarm among pediatricians. Some at risk pediatric patients with recurrent and/or chronic GERD have been linked to adulthood GERD. In this paper, pediatric GERD with and without erosive esophagitis was reviewed along with treatment options and issues specifically for the otherwise healthy older children and adolescents in the primary clinics or the secondary hospitals.