Gastroesophageal reflux in children with a congenital abdominal wall defect
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Published on: August 25, 2015
A Koivusalo1, R Rintala, H Lindahl
1Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland.
Insights
Gastroesophageal reflux (GER) is common in children with congenital abdominal wall defects (CAWD), particularly those with omphalocele and large defects, often leading to esophagitis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Gastroesophageal reflux (GER) is frequently observed in infants with congenital abdominal wall defects (CAWD).
- Understanding GER prevalence is crucial for managing these complex pediatric cases.
Purpose of the Study:
- To determine the incidence of GER in children diagnosed with CAWD.
- To compare GER frequency between patients with omphalocele and gastroschisis.
- To investigate the association between defect size and GER in CAWD patients.
Main Methods:
- Esophagoduodenoscopy with biopsies and 18-hour esophageal pH-monitoring were performed on 42 children (19 gastroschisis, 23 omphalocele).
- Patients were assessed at a median age of 12 months.
Main Results:
- GER was diagnosed in 13 patients (31%), with most cases (12/13) exhibiting esophagitis.
- The incidence of GER was higher in omphalocele (43%) compared to gastroschisis (16%), though not statistically significant.
- GER was significantly more common in patients with large defects (70%) versus small defects (19%) requiring primary fascial closure (P < .01).
Conclusions:
- Congenital abdominal wall defect patients, especially those with omphalocele and large defects, experience a high rate of GER.
- GER in these pediatric patients frequently presents with esophagitis within the first few years of life.
Background/Purpose:
Gastroesophageal reflux (GER) is considered common in patients with congenital abdominal wall defects (CAWD). The aim of this study was to find out the frequency of GER in children with CAWD and, in particular, whether there is difference between patients with omphalocele and gastroschisis.
Methods:
Forty-two children, 19 with gastroschisis and 23 with omphalocele were examined for GER at the median age of 12.0 months (range, 1 to 132). Esophagoduodenoscopy with biopsies was performed on all patients. Eighteen patients underwent 18-hour esophageal pH-monitoring.
Results:
GER was detected in 13 patients. All but one patient of the 13 had either macroscopic or microscopic esophagitis. One patient had pathological pH monitoring only. In children with omphalocele, the incidence of GER was 43% (10 of 23), whereas in gastroschisis patients the incidence was 16% (3 of 19), (P value, not significant). The median age of omphalocele patients with GER was significantly lower (7 months) than the median age of those without GER (72 months; P = .01). In patients with gastroschisis age made no difference. Six of 32 patients (19%) with primary fascial closure (small defects) had GER, whereas 7 of 10 patients (70%) in which primary fascial closure was impossible (large defects) had GER (P < .01).
Conclusion:
CAWD patients, especially those with omphalocele and a large defect have a high incidence of GER complicated by esophagitis during the first few years of life.
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