BOSTON — Gastroesophageal reflux disease is common, but often goes undiagnosed in children with severe generalized cerebral palsy, Dr. Rob Rieken reported at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.
In a cross-sectional study of 29 children with intellectual and severe motor disability (IQ less than 55 and Gross Motor Function Classification System levels I-IV), the prevalence of Gastroesophageal reflux disease (GERD)—based on 24-hour pH monitoring—was 59%, Dr. Rieken reported in a poster.
The mean duration of reflux periods was 10% of the total recording time, compared with a normal percentage of less than 4%.
There was no significant difference in the percentage reflux times between upright and supine periods (perhaps because of the high use of anti-Trendelenburg's positioning of the bed in children with cerebral palsy), but compared with upright periods, the percentage reflux time postprandially was significantly greater. This is likely explained by a higher frequency of transient relaxation of the lower esophageal sphincter, decreased lower esophageal sphincter tone, and/or delayed gastric emptying in the study population, explained Dr. Rieken, of Erasmus University Medical Center, Rotterdam, the Netherlands.
In more than half of the children with GERD, the diagnosis following the recording was new, and only half of those with a prior GERD diagnosis were receiving treatment. But 40% of those who were shown in this study not to have GERD were being treated for the disease, he noted.
The findings suggest that the diagnosis of GERD is frequently missed in children with cerebral palsy, and they show that pH measurement is a feasible method for assessing this population, Dr. Rieken concluded.