A systematic review with meta-analysis of the prevalence of gastroesophageal reflux in congenital diaphragmatic hernia pediatric survivors

Abstract

Congenital diaphragmatic hernia survivors are a well-known group at risk for developing gastroesophageal reflux disease that may be particularly long-term severe. The aim of this study is to provide a systematic review of the prevalence of gastroesophageal reflux in infant and children survivors treated for congenital diaphragmatic hernia.Electronic and manual searches were performed with keywords related to congenital diaphragmatic hernia, gastroesophageal reflux disease, and epidemiology terms. Summary estimates of the prevalence were calculated. Effect model was chosen depending on heterogeneity (I2). Factors potentially related with the prevalence, including study quality or the diagnostic strategy followed, were assessed by subgroup and meta-regression analyses. Risk of publication bias was studied by funnel plot analysis and the Egger test.The search yielded 140 articles, 26 of which were included in the analyses and provided 34 estimates of prevalence: 21 in patients aged 12 months or younger, and 13 in older children. The overall prevalence of gastroesophageal reflux disease in infants was 52.7% (95% confidence interval [CI]: 43.2% to 62.1%, I2 = 88.7%) and, in children over 1 year old, 35.1% (95% CI: 25.4% to 45.3%, I2 = 73.5%). Significant clinical and statistical heterogeneity was found. The strategy chosen for gastroesophageal reflux diagnosis influenced the reported prevalence. The only estimate obtained with a systematic use of multichannel intraluminal impedance provided a higher prevalence in both age groups: 83.3% (95% CI: 67.2% to 93.6%) and 61.1% (95% CI: 43.5% to 76.9%) respectively. This last prevalence did not significantly differ from that obtained using only low risk of bias estimates.As a conclusion, gastroesophageal reflux disease is commonly observed after congenital diaphragmatic hernia repair and is almost constantly present in the first months of life. It may be underdiagnosed if systematically esophageal monitoring is not performed. This should be considered when proposing follow-up and management protocols for congenital diaphragmatic hernia survivors.

Long-term feeding issue and its impact on the daily life of congenital diaphragmatic hernia survivors: results of the first patient-led survey

“…The most common feeding issue is GER, being reported by over 90% of responders. Previous reports have described the incidence of GER in CDH survivors as 30-60% with variability depending on diagnostic criteria [18][19][20]. We assume the higher rate in our result is representing the recognition of the patients, reporting reflux as any vomit or regurgitation.…”

“…These facts indicate that GER is common, but non-negligible condition, recommending clinicians to carefully detect a sign of reflux and apply antipeptic therapy at proper timing. Fortunately, it is reported that the incidence of GER decreases after 1 year of age [18,21].…”

A narrative review of gastroesophageal reflux in the pediatric patient

“…It is reasonable to counsel families that symptoms typically improve after 1 year of age in the overwhelming majority of healthy infants. GERD does, however, demonstrate an increased prevalence in children affected by: prematurity, obesity, neurological impairment, congenital heart disease, congenital diaphragmatic hernia, gastrointestinal (GI) tract abnormalities, and chromosomal abnormalities (2,(14)(15)(16)(17)(18)(19)(20)(21). Refractory GERD refers to GERD symptoms that do not respond to medical treatment after 8 weeks (10).…”

Gastroesophageal reflux in children: an updated review

“…Gastroesophageal reflux disease is more prevalent in children with obesity, neurological impairment, congenital heart disease, abnormalities of the gastrointestinal tract, congenital diaphragmatic hernia, and chromosomal abnormalities 27–35. Obesity is an important predisposing factor.…”