Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Pediatric Surgery Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy.
Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
J Pediatr Surg. 2024 Oct;59(10):161593. doi: 10.1016/j.jpedsurg.2024.06.002. Epub 2024 Jun 8.
Gastroesophageal reflux disease (GERD) is a common comorbidity associated with congenital diaphragmatic hernia (CDH), with reported cases of Barrett's esophagus (BE) and esophageal adenocarcinoma before the age of 25. The prevalence and natural course of GERD in CDH survivors remain uncertain due to variations in diagnostic methods. We aimed to analyse the GERD prevalence from infancy through young adulthood.
We retrospectively analyzed pH-impedance measurements and endoscopic findings in 96 CDH survivors evaluated as routine care using well established clinical protocols. GERD was defined as an abnormal acid exposure time for pH-MII measurements and as presence of reflux esophagitis or BE at upper endoscopy. Clinical data including symptoms at time of follow-up and use of antireflux medication were collected.
GERD prevalence remained consistently low (≤10%) across all age groups, yet many patients experienced GER symptoms. Histological abnormalities were observed in 80% of adolescents and young adults, including microscopic esophagitis in 50%. BE was diagnosed in 7% before the age of 18, all had GER symptoms. CDH severity, anatomy at the time of CDH correction, alcohol usage, and smoking did not emerge as significant risk factors for GERD.
Given the low GERD prevalence in CDH survivors, a symptom-driven approach to diagnosis and follow-up is warranted. We advise long-term follow-up for all adult patients due to the early onset of BE and the limited evidence available. The longitudinal course and impact of GERD on other long-term CDH-related comorbidities should be explored in larger cohorts.
Not applicable.
胃食管反流病（GERD）是一种与先天性膈疝（CDH）相关的常见合并症，有报道称在 25 岁之前就出现了 Barrett 食管（BE）和食管腺癌病例。由于诊断方法的差异，CDH 幸存者中 GERD 的患病率和自然病程仍不确定。我们旨在分析从婴儿期到成年早期 GERD 的患病率。
我们回顾性分析了 96 例 CDH 幸存者的 pH 阻抗测量和内镜检查结果，这些患者是按照既定的临床方案进行常规评估的。GERD 定义为 pH-MII 测量时酸暴露时间异常和上消化道内镜检查时存在反流性食管炎或 BE。收集了包括随访时症状和使用抗反流药物在内的临床数据。
GERD 的患病率在所有年龄段均保持较低（≤10%），但许多患者存在 GER 症状。80%的青少年和年轻人存在组织学异常，其中 50%存在显微镜下食管炎。7%的患者在 18 岁之前被诊断为 BE，所有患者均有 GER 症状。CDH 严重程度、CDH 矫正时的解剖结构、酒精使用和吸烟并未成为 GERD 的显著危险因素。
鉴于 CDH 幸存者中 GERD 的患病率较低，需要根据症状进行诊断和随访。由于 BE 的发病较早且现有证据有限，我们建议对所有成年患者进行长期随访。应在更大的队列中探讨 GERD 对其他长期 CDH 相关合并症的纵向病程和影响。
不适用。
