Pediatric Gastroesophageal Reflux Disease: Systematic Review on Prognosis and Prognostic Factors

Area of Science:

• Pediatric Gastroenterology
• Clinical Epidemiology

Background:

• Pediatric gastroesophageal reflux disease (GERD) is common, but its long-term prognosis and factors influencing outcomes are not well-established.
• Understanding prognosis is crucial for managing pediatric GERD and preventing complications.

Purpose of the Study:

• To systematically review and summarize the existing evidence on the prognosis and prognostic factors of pediatric GERD.
• To assess the quality and heterogeneity of available prognostic studies in pediatric GERD.

Main Methods:

• A comprehensive literature search was conducted in Embase and MEDLINE/PubMed from inception to April 2016.
• Four publications met the inclusion criteria for the systematic review, with a moderate-to-high risk of bias noted.
• Definitions of GERD and outcome measures varied significantly across the included studies.

Main Results:

• Among children diagnosed with GERD and esophagitis, symptom persistence (weekly symptoms) ranged from 23% to 68% (on antireflux medication) at follow-up (12 months to >5 years), depending on the definition used.
• In children with GERD but without esophagitis, 1.4% developed esophagitis at follow-up (>5 years), and none developed Barrett esophagus.
• The quality of prognostic studies was limited, with substantial methodological heterogeneity observed.

Conclusions:

• Prognostic studies on pediatric GERD are of limited quality and exhibit significant methodological heterogeneity.
• The current evidence is insufficient to identify specific children at risk for unfavorable outcomes regarding GERD symptoms or endoscopic complications.
• Further high-quality research is needed to establish reliable prognostic factors for pediatric GERD.