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Gastro-oesophageal reflux and oesophageal dysfunction in children and adolescents with brain damage
1Department of Paediatrics, Faculty of Health Sciences, University Hospital, Linköping, Sweden.
Insights
Pathological gastro-oesophageal reflux (GOR) and oesophageal dysfunction (OD) are common in children with brain damage. These conditions are linked to serious complications, including fatal outcomes from aspiration pneumonia.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Clinical Diagnostics
Background:
- Children with brain damage, particularly severe cerebral palsy and tetraplegia, often experience gastrointestinal issues.
- Gastro-oesophageal reflux (GOR) and oesophageal dysfunction (OD) are suspected complications in this vulnerable population.
Purpose of the Study:
- To investigate the prevalence of pathological GOR and OD in children with brain damage.
- To identify associated complications and outcomes in these patients.
Main Methods:
- 32 children (0.7-19 years) with brain damage underwent 24-hour esophageal pH monitoring and manometry.
- Radiological examinations, chest radiography, and blood tests for iron deficiency were also performed.
Main Results:
- 47% had mild, 16% moderate-severe, and 16% severe pathological acid GOR.
- 22% had no pathological GOR. Abnormal manometry (10 patients) and esophageal radiography (9 patients) were noted.
- Iron deficiency and anemia were present in 13 and 5 patients, respectively. Three had lung consolidations. Two severe GOR patients died from suspected aspiration pneumonia.
Conclusions:
- Pathological GOR and OD are frequent in children with brain damage.
- These conditions are associated with significant complications, including a fatal course, highlighting the need for early detection and management.
Abstract:
The prevalence of pathological gastro-oesophageal reflux (GOR) and oesophageal dysfunction (OD) was investigated in 32 children, 0.7-19 years of age (mean 11.2 years), with brain damage, mainly severe cerebral palsy and tetraplegia. They underwent 24-h pH monitoring in the distal oesophagus and oesophageal manometry. In addition, radiological examination of the oesophagus, chest radiography, blood counts and blood tests for iron deficiency were carried out. Fifteen (47%) patients had mild pathological acid reflux, 5 (16%) had moderately severe and 5 (16%) severe acid GOR. Seven of 32 (22%) patients had no pathological GOR. Ten patients had abnormal manometry findings and 9 had a pathological radiological oesophagus examination. Three patients had radiographic lung consolidations. Thirteen patients had iron deficiency and 5 were anaemic. Two patients with severe acid reflux have died, presumably from aspiration-induced pneumonia. Findings of OD and GOR are frequent in children with brain damage and are related to significant complications, including fatal course.