Gastroesophageal reflux in children with a congenital abdominal wall defect

Abstract

Background/purpose: Gastroesophageal reflux (GER) is considered common in patients with congenital abdominal wall defects (CAWD). The aim of this study was to find out the frequency of GER in children with CAWD and, in particular, whether there is difference between patients with omphalocele and gastroschisis.

Methods: Forty-two children, 19 with gastroschisis and 23 with omphalocele were examined for GER at the median age of 12.0 months (range, 1 to 132). Esophagoduodenoscopy with biopsies was performed on all patients. Eighteen patients underwent 18-hour esophageal pH-monitoring.

Results: GER was detected in 13 patients. All but one patient of the 13 had either macroscopic or microscopic esophagitis. One patient had pathological pH monitoring only. In children with omphalocele, the incidence of GER was 43% (10 of 23), whereas in gastroschisis patients the incidence was 16% (3 of 19), (P value, not significant). The median age of omphalocele patients with GER was significantly lower (7 months) than the median age of those without GER (72 months; P = .01). In patients with gastroschisis age made no difference. Six of 32 patients (19%) with primary fascial closure (small defects) had GER, whereas 7 of 10 patients (70%) in which primary fascial closure was impossible (large defects) had GER (P < .01).

Conclusion: CAWD patients, especially those with omphalocele and a large defect have a high incidence of GER complicated by esophagitis during the first few years of life.