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Gastroesophageal reflux and behavior in neurologically impaired children
Alja Gössler1, Johannes Schalamon, Andrea Huber-Zeyringer
1Department of Pediatric Surgery, University of Graz, Medical School, 8036 Graz, Austria. aljagoessler@yahoo.com
Insights
In children with severe neurologic impairment, agitated or autoaggressive behavior may signal gastroesophageal reflux (GER). This study found a link between reflux severity, pain-related behaviors, and esophageal inflammation in these children.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Behavioral Science
Background:
- Gastroesophageal reflux (GER) is common in children with severe neurologic impairment.
- Behavioral changes can be indicators of underlying medical conditions in non-verbal or communication-impaired children.
Purpose of the Study:
- To investigate the association between gastroesophageal reflux (GER) and behavioral patterns indicative of pain in children with severe neurologic deficits.
- To determine if specific behaviors correlate with the severity of GER and esophageal inflammation.
Main Methods:
- Prospective evaluation of 19 children with severe neurologic impairment suspected of GER.
- Utilized 24-hour pH monitoring and endoscopic investigations with mucosal biopsies.
- Behavioral patterns were documented by caregivers and classified into agitation and autoaggressive behaviors.
Main Results:
- Children with autoaggressive behavior exhibited significantly higher reflux indices (P < .01) and esophageal inflammation compared to those with agitation only.
- A significant correlation was found between the severity of GER (reflux index) and the presence of behavioral abnormalities (P < .0004).
- Esophageal inflammation was significantly higher in children with behavioral abnormalities than in those without.
Conclusions:
- Autoaggressive behavior or significant agitation in neurologically impaired children may indicate pathologic GER.
- The severity of GER correlates with behavior patterns suggesting pain, highlighting GER as a potential cause.
- Excluding pathologic GER is crucial in neurologically impaired children with behavioral issues to prevent complications and enhance quality of life.
Objective:
This study aimed to evaluate a possible link between gastroesophageal reflux (GER) and behavior pattern indicating pain experience in a group of children with severe neurologic deficits.
Patients And Methods:
We prospectively evaluated 19 patients with severe neurologic impairment (10 males and 9 females; mean age, 12.7 years) suspected for GER before and after initial treatment. Repeated 24-hour pH monitorings were performed in 19 children, whereas additional repeated endoscopic investigations were carried out in 18. In these children a histologic examination of mucosal biopsies was performed. Behavior pattern was described by parents or caregivers. The level of activity was classified as no/occasional agitation, daily agitation, and autoaggressive behavior.
Results:
The behavioral pattern of the children was most frequently (n = 24) described as "agitated" followed by "autoaggressive" behavior (n = 10). Neither autoaggression nor agitation was less frequent (n = 4). Children with autoaggressive behavior had a significantly higher reflux index compared with the neurologically impaired patients with agitation only (P < .01). The reflux index was significantly higher in children with behavioral abnormalities than in children without abnormalities (P < .0004). In children without agitation or autoaggression, the pH measurements were all normal. Biopsies of esophageal mucosa revealed inflammation in 27 cases (first degree in 9; second degree in 12, and third degree in 6). Patients with autoaggressive behavior and those with agitation only had a significantly higher degree of inflammation compared with children without behavioral abnormalities (1.77 and 1.35 vs 0.25, respectively; P < .05). The degree of inflammation did not differ significantly among children with behavioral abnormalities.
Discussion:
The present study suggests that in children with severe neurologic impairment, autoaggressive behavior or considerable agitation may be a marker for reoccurring or first-time-diagnosed pathologic GER. The severity of reflux correlates significantly to the behavior pattern resulting from experiencing pain. Pathologic GER should be excluded in all neurologically impaired children with behavioral abnormalities to prevent reflux-related complications and improve health-related quality of life.
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