Is there a pattern in gastroesophageal reflux disease in children with cerebral palsy: Multicenter study

Abstract

Objective:To determine if there is a pattern of gastro-oesophageal reflux disease (GERD) with distinctive phimedanciometry (pHMII) values in those children with cerebral palsy who have a symptomatic correlation compared to those who do not.Methods:A retrospective, descriptive and analytical multicentre study. Included children with cerebral palsy (PC), aged 1 to 15 years, evaluated from May 2017 to December 2023 in centre of Latin America and Spain, diagnosed with GERD by pHMII.The population consisted of 80 children divided into two groups: Group 1, children without symptomatic correlation (n=52) and Group 2, children with symptomatic correlation (n=28).Symptomatic correlations were defined by the presence of two of the following: Symptom Index (SI), Symptom Sensitivity Index (SSI) or Symptom Associated Probability (SAP). Only those with at least 5 symptom occurrences were considered.We excluded children under 1 year of age, patients with esophageal atresia, previous Nissen surgery, diaphragmatic hernia, treatment with antacids or prokinetics during the trial, and trial duration of less than 18 hours. All patients underwent 24-hour pHMII according to the same protocol.The tracing were analysed automatically in BioVIEW software and then manually.Linear regressions were conducted with symptomatic correlation as the dependent variable to assess differences among the groups, including mean differences and analyses of variance, with a significance level set at 0.05Results: Patients in both groups had both gastrointestinal and extra-gastrointestinal symptoms, with more respiratory symptoms in group 2. Group 2 also had a longer acid clearance time (ACT), although the difference was not statistically significant (t(33)=-0.5, p=0.6)(graph1). The total number of gastro-oesophageal reflux (GER) and the number of GER reaching the upper channels had a higher mean for both values in group 2, but these differences were not statistically significant (t(70)=0.18, p=0.8 and t(66)=-0.9, p=0.3, respectively).Conclusions: Although a pattern cannot be determined in this population, we observed a trend in which patients with positive symptomatic correlation, have a higher number of proximal refluxes and prolonged ACT. Prospective studies with a larger number of patients are needed to establish a differentiation.