Gastroesophageal Reflux Disease in Children with Cystic Fibrosis

Abstract

Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

Oral cavity health among cystic fibrosis patients: Literature overview

“…Gastroesophageal Reflux Disease (GERD) has a complex pathogenesis, and its intensification may directly impact the progression of bronchopulmonary dysplasia. 9 Increased pain and flatulence may be caused by Distal Intestinal Obstruction Syndrome (DIOS). Partial DIOS is diagnosed when the fecal mass is retained in the ileocecal area.…”

An updated review on gastro-esophageal reflux in pediatrics

“…The authors could not find a relation between gastric emptying and MIIpH results in children with cystic fibrosis (CF) [15]. Acidity of the refluxate may also relate to a localized proximal gastric area called 'the gastric acid pocket' that may persist even in the postprandial period when (the rest of the) stomach content is neutralized by the meal [16].…”

Gastroesophageal Reflux Disease and Need for Antireflux Surgery in Children with Cystic Fibrosis: A Systematic Review on Incidence, Surgical Complications, and Postoperative Outcomes

“…Seven of the 10 articles were eligible for detailed analysis of GERD incidence in pediatric CF cohorts (►Table 1). [11][12][13][14][15][16][17] In total, there were 212 children with CF available for analysis, of which 108 (51%) were male. The median number of patients in the study cohort was 28 (range, 8-44) with an age range from 0.5 months to 20 years.…”

“…[12][13][14][15] Two later articles (published in 2015 and 2016) used pH-impedance monitoring to investigate GERD and the diagnosis were based on RIs >6 and >5%, respectively. 16,17 However, symptom correlation for pH or pH-impedance studies was not included in their methodologies. Dziekiewicz et al specifically reported that they were unable to calculate symptom correlation parameters as patients or their parents did not note any specific symptoms.…”