Review of the persistence of gastroesophageal reflux disease in children, adolescents and adults: does gastroesophageal reflux disease in adults sometimes begin in childhood?

Abstract

Objective. Understanding the natural history and outcomes of gastroesophageal reflux disease (GERD) in children could help to identify patients at risk of having GERD complications during adulthood. This review aimed to assess evidence of whether GERD in children or adolescents persists into adulthood. Material and methods. PubMed searches (1966–2010) identified longitudinal studies of GERD extending from childhood/infancy into adulthood, as well as longitudinal studies within pediatric age groups. Results. In one study, heartburn during childhood was more often recalled by adults with reflux symptoms than by those without (30% vs. 9%; p < 0.001), as was medication or surgery for GERD (both p < 0.01). Another study found that GERD symptoms were more common in adults diagnosed with reflux esophagitis during childhood/adolescence than in those who were not (46% vs. 30%). Regurgitation during infancy increased the risk of feeding problems after 1 year (odds ratio 4.2 (95% confidence interval: 1.4–12.0)) and of reflux symptoms at 9 years of age (relative risk 2.3 (95% confidence interval: 1.3–4.0)). In one study, abnormal esophageal histology persisted in infants after 12 months without reflux symptoms. A proportion (59–100%: three studies) of patients with reflux symptoms and/or reflux esophagitis during the pediatric years still required treatment after 1–8 years. In another study, however, just 7% of patients with healed reflux esophagitis relapsed after 9 months without treatment. Conclusion. The limited available evidence suggests that some infants, children, and adolescents with GERD are more likely than those without GERD to have symptoms later in life.

Key Words::

• Gastroesophageal reflux disease
• pediatric
• reflux esophagitis

Acknowledgments

Dr Anja Becher and Dr Michael Bland of Oxford PharmaGenesis™ Ltd provided writing support, funded by AstraZeneca R&D, Mölndal, Sweden.

Declaration of interest : Dr H.S. Winter has received research funding from AstraZeneca, TAP Pharmaceuticals, Wyeth and Procter & Gamble. Dr M. Illueca is an employee of AstraZeneca. At the time this study was conducted, Dr C. Henderson was an employee of Oxford PharmaGenesis Ltd, which has received funding from AstraZeneca. Dr M. Vaezi has received research funding from AstraZeneca, TAP Pharmaceuticals and Restech.