Risk factors and possibilities of preventing gastroesophageal reflux disease in school-age children
Background. The article presents the main problems of early diagnosis of gastroesophageal reflux disease (GERD) in school-age children, which leads to late detection and initiation of treatment. The purpose of the study was to identify the main risk factors that may predispose the development of this disease, as well as triggers that provoke GERD in school-age children. Knowledge of risk factors can help prevent the formation of GERD in children, and, with timely diagnosis of therapy, reduce the severity of the disease and improve quality of life. Materials and methods. Open comparative study included 98 school-age children (31 girls, 67 boys) aged 6 to 18 years (mean age 14.2 years). Diagnosis of gastroesophageal reflux disease was conducted in accordance with the Order of the Ministry of Health of Ukraine dated January 29, 2013, No. 59 “On Approval of Unified Clinical Protocols for Medical Care of Children with Digestive Disorders”. During the comprehensive examination, the identification of possible risk factors was made, for which a detailed history collection was performed: the nature of the child’s nutrition and the regularity of the meal were evaluated, as well as the mode of the day, the presence and intensity of physical activity, the presence of chronic stress (psycho-traumatic situations), sleep duration, bad habits, false eating habits. Past medical history also revealed the duration of breastfeeding and the time of supplementary food introduction. Physical examination was also aimed at the detection of so-called symptoms of anxiety — “red flags” that may indicate the presence of complications or organic pathology. Results. In both age groups, boys were dominant; besides, there were significantly more children aged 13–17 years in the group with GERD. Early administration of supplements was revealed in both groups, as well as early artificial/mixed feeding. More than 85 % of children had signs of autonomic dysregulation and concomitant pathology of the upper digestive tract. Interestingly, body mass index met norms in most patients, so this risk factor was not significant. Conclusions. The study has revealed the main risk factors that contribute to the formation of GERD in children of two age groups: 6–12 and 13–17 years, and the relationship between individual risk factors with different forms of GERD was analyzed. Optimization of the primary screening diagnosis of GERD can be achieved by using adapted pediatric GERD questionnaire at the outpatient stage of medical care. It includes not only questions about typical esophageal clinical symptoms, but also extravascular and atypical GERD symptoms. Most of the risk factors and trigger factors are modified, so at the stage of primary care, the control of children’s status who are at risk of GERD, timely diagnosis and correction of risk factors, or reflux disorders which occur in the presence of these factors will prevent the development of disease or its severe course that will improve the quality of life of the patient.
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Singendonk MMJ, Tabbers MM, Benninga MA, Langendam MW. Pediatric Gastroesophageal Reflux Disease: Systematic Review on Prognosis and Prognostic Factors. J Pediatr Gastroenterol Nutr. 2018 Feb;66(2):239-243. doi: 10.1097/MPG.0000000000001697.
National Collaborating Centre for Women's and Children's Health (UK). Gastro-Oesophageal Reflux Disease: Recognition, Diagnosis and Management in Children and Young People. London: National Institute for Health and Care Excellence (UK); 2015 Jan. (NICE Guideline, No. 1.)
Oh TH. Accuracy of the Diagnosis of GORD by Questionnaire, Physicians and a Trial of Proton Pump Inhibitor Treatment: The Diamond Study (Gut 2010;59:714-721). J Neurogastroenterol Motil. 2011 Jan;17(1):98-9. doi: 10.5056/jnm.2011.17.1.98.
Hunt R, Armstrong D, Katelaris P, et.al. Review Team: World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease. J Clin Gastroenterol. 2017 Jul;51(6):467-478. doi: 10.1097/MCG.0000000000000854.
Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516-554. doi:10.1097/MPG.0000000000001889.
Voloshin OM, Chumak OYu. Undifferentiated connective tissue dysplasia and respiratory diseases in children and adolescents (review of literature). Zdorovʹe rebenka. 2017;12(6):720-727. doi: 10.22141/2224-05184.108.40.2067.112842.
Parkhomenko LK, Strashok LA, Zavelya EM, Isakova MYu, Yeshchenko AV, Polishchuk ZhV. Clinical and endoscopic features of the upper digestive tract pathology in children and adolescents depending on age. Zdorovʹe rebenka. 2017;12(8):895-899. doi: 10.22141/2224-05220.127.116.117.119245.
Okimoto E, Ishimura N, Morito Y, et al. Prevalence of gastroesophageal reflux disease in children, adults, and elderly in the same community. J Gastroenterol Hepatol. 2015 Jul;30(7):1140-6. doi: 10.1111/jgh.12899.
Bortoli N, Ottonello A, Zerbib, F, Sifrim, D, Gyawali CP, Savarino E. Between GERD and NERD: the relevance of weakly acidic reflux. Ann N Y Acad Sci. 2016 Sep;1380(1):218-229. doi: 10.1111/nyas.13169.
GERD (Gastroesophageal Reflux Disease) in Children. Available from: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/pediatrics/gerd_gastroesophageal_reflux_disease_in_children_90,p01994. Accessed: July 24, 2015.
Mosli M, Alkhathlan B, Abumohssin A, et al. Prevalence and clinical predictors of LPR among patients diagnosed with GERD according to the reflux symptom index questionnaire. Saudi J Gastroenterol. 2018 Apr 13. doi: 10.4103/sjg.SJG_518_17.
Chirila I, Morariu ID, Barboi OB, Drug VL. The role of diet in the overlap between gastroesophageal reflux disease and functional dyspepsia. Turk J Gastroenterol. 2016 Jan;27(1):73-80. doi: 10.5152/tjg.2015.150238.
Vieira SCF, Gurgel FM, Leão MZ, et al. Survey on the Adherence to the 2009 NASPGHAN-ESPGHAN Gastroesophageal Reflux Guidelines by Brazilian Paediatricians. J Pediatr Gastroenterol Nutr. 2018 Feb 1. doi: 10.1097/MPG.0000000000001902. [Epub ahead of print]
Mehta P, Furuta GT, Brennan T, et al. Nutritional State and Feeding Behaviors of Children with Eosinophilic Esophagitis and Gastroesophageal Reflux Disease. J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):603-608. doi: 10.1097/MPG.0000000000001741.
Chiu JY, Wu JF, Ni YH. Correlation Between Gastroesophageal Reflux Disease Questionnaire and Erosive Esophagitis in School-aged Children Receiving Endoscopy. Pediatr Neonatol. 2014 Dec;55(6):439-43. doi: 10.1016/j.pedneo.2014.01.004.
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