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[Long-term follow-up of infants with pathological gastroesophageal reflux]
P Pesendorfer1, M E Höllwarth, E Uray
1Univ. Klinik für Kinderchirurgie Graz.
Insights
Gastroesophageal reflux (GER) in infants often resolves spontaneously by age one, but persistent GER can occur. Some children require surgery for complicated GER, highlighting the need for ongoing monitoring.
Area of Science:
- Pediatric Gastroenterology
- Digestive Health
- Infant Health
Context:
- Investigated 330 infants with suspected gastroesophageal reflux (GER) between 1981-1984.
- Utilized combined esophageal manometry and pH-monitoring for diagnosis.
- Defined pathological GER by a manometric reflux time exceeding 1%.
Purpose:
- To assess the natural history and long-term outcomes of pathological GER in infants.
- To evaluate the effectiveness of conservative therapy for GER.
- To determine the incidence of spontaneous healing and complications.
Summary:
- Follow-up studies indicated that two-thirds of infants still exhibited pathological GER after one year of conservative therapy.
- At two years of age, one-third of patients continued to show pathological GER.
- Approximately 5.4% of all investigated children required surgery for complicated GER.
- Long-term follow-up (over five years) revealed spontaneous GER resolution in some cases by age four to five.
- Persistent pathological GER was observed in about 8% of cases beyond five years, posing a risk of complications.
Impact:
- Provides insights into the spontaneous resolution rates of GER in children.
- Highlights the potential for long-term GER persistence and associated risks.
- Informs clinical management strategies for infants diagnosed with GER.
- Contributes to understanding the natural course of GER disease in pediatric populations.
Abstract:
Between 1981 and 1984 330 infants with suspected gastroesophageal reflux (GER) were investigated by combined esophageal manometry and pH-monitoring. GER of 283 patients with a manometric reflux time more than 1% was classified as pathologic. After one year of conservative therapy a follow-up-study mainly by 24-hour-pH-monitoring could be performed in 108 patients. Two thirds (76 out of 108) still showed a pathological GER. In the age of about two years follow-up-investigation in 41 patients showed in one third of them (13 out of 41) a pathological GER. 5.4% of all investigated children (18 out of 330) hat to be operated because of complicated GER. Follow-up has been performed in 24 children over five years with manometry and/or pH-monitoring and/or barium swallow and/or endoscopy with biopsy. After one year of conservative therapy more than two thirds of them (19 out of 24), after two years one third (eight out of 24) showed a pathological GER. In a few cases (four out of 24) the pathological GER disappeared spontaneously in the age of four to five years. In the age of 1.5 to three years six children had to be operated because of complicated GER. We conclude from this study that a spontaneous healing of pathological GER occurs in about two thirds of the patients older than one year. In about 8% (two out of 24) a pathological GER persists over the fifth year of life representing a permanent risk of GER complications.