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[Gastroesophageal reflux in pediatric neurologic patients]
M L Vega Gutiérrez1, C Benito Fernández, M J Alvarez Gómez
1Departamento de Pediatría, Unidad de Neurología Infantil, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra, Pamplona.
Insights
Gastroesophageal reflux (GER) is highly prevalent in pediatric patients with severe motor impairments, particularly tetraparetic cerebral palsy (T-CP). Surgical intervention for GER offers better outcomes than medical treatment in these neurologically impaired children.
Area of Science:
- Pediatric Neurology
- Gastroenterology
Context:
- Neurologic pediatric patients often present with complex comorbidities.
- Gastroesophageal reflux (GER) is a common concern in infants with severe motor and/or psychiatric involvement.
Purpose:
- This retrospective study evaluated the incidence of GER in 140 pediatric patients with neurologic conditions.
- To determine the prevalence of GER in relation to specific neurological deficits.
Summary:
- GER was diagnosed in 27 patients (19.3%), with a significantly higher incidence in those with tetraparetic cerebral palsy (T-CP) (90.5%) and moderate to severe mental retardation (ms-MR) (25%).
- Patients with T-CP showed a very significant difference in GER frequency compared to other groups (p < 0.001).
- Treatment outcomes favored surgical intervention (90% good control) over medical management (55% good control) for GER.
Impact:
- Highlights the critical need for GER screening in pediatric patients with severe motor impairments, especially T-CP.
- Suggests that surgical treatment for GER may lead to improved quality of life in this vulnerable population.
- Informs clinical practice regarding the management of GER in neurologically impaired children.
Abstract:
With the aim of evaluating the incidence of gastroesophageal reflux (GER) in neurologic pediatric patients with severe motor and/or psychiatric involvement, a retrospective study of 140 infants followed at the Neuropediatric Unit was realized. Forty-five patients (32.1%) had moderate to severe mental retardation (ms RR), 21 of these patients had associated tetraparetic cerebral palsy (T-CP). The rest of the infants presented variable degrees of neurologic involvement: 25 diplegic (D-CP), 27 hemiparetic (H-CP), 22 with slight mental retardation or borderline IQ without motor deficit (SMR), and 21 had attention deficit disorder with hyperactivity (ADD-H). The diagnosis of GER was based on clinical symptomatology and barium ingestion with fluoroscopy and/or esophagoscopy. GER was confirmed in 27 patients: 19 (90.5%) with T-CP, 6 (25%) with ms-MR and 2 (8%) with D-CP. The rest of the infants did not have GER. There was a very significant difference in the frequency of GER in the T-CP group with respect to the other groups (p < 0.001) and a significant difference in the ms-MR patients with respect to the other groups (p < 0.05). The treatment of GER was surgical in ten patients (37%), after failure of medical treatment in 8; exclusively medical treatment in 10 cases (37%) and postural and dietetic treatment in 7 (26%) patients. Good control of GER, resulting in an improvement in the quality of life, occurred in 90% of the patients treated surgically and only in 55% of the patients treated medically.(ABSTRACT TRUNCATED AT 250 WORDS)