Follow-up of a cohort of children and adolescents with gastro-esophageal reflux disease who were free of reflux esophagitis at initial diagnosis

Abstract

Objective. Few studies have examined the incidence of complications from gastro-esophageal reflux disease (GERD) in children and adolescents in primary care. Here we aimed to describe the natural history of GERD in a pediatric population with no reflux esophagitis at initial diagnosis, assessing diagnoses of new esophageal complications and extra-esophageal conditions. Material and methods. We used The Health Improvement Network UK primary care database (which includes data on more than 2 million patients) to identify individuals aged 1–17 years with a first diagnosis of gastro-esophageal reflux or heartburn in the period 2000–2005, via a computerized search followed by a manual review of the patient records. This search identified 1242 individuals with an incident diagnosis of GERD but no record of esophagitis. This cohort was followed-up to detect new diagnoses of esophageal complications and extra-esophageal conditions. Results. During a mean follow-up period of almost 4 years, 40 children and adolescents had a confirmed new diagnosis of reflux esophagitis (incidence: 10.9 per 1000 person-years). No cases of Barrett's esophagus, esophageal stricture or esophageal ulcer were reported. Individuals with GERD had double the risk of an extra-esophageal condition such as asthma, pneumonia, cough or chest pain compared with children and adolescents with no diagnosis of GERD. Conclusions. Children and adolescents with GERD may be at risk of developing reflux esophagitis and a range of other extra-esophageal conditions, but more severe esophageal complications are rare.

Key Words::

• Epidemiology
• esophageal-disorders
• gastro-esophageal reflux
• GERD
• reflux esophagitis
• pediatric
• primary health care

Acknowledgements

We would like to thank Catherine Hill, from Oxford PharmaGenesis™ Ltd., who provided writing support funded by AstraZeneca R&D Mölndal.

Declaration of interest: Luis A García Rodríguez and Ana Ruigómez have served as speakers, consultants and advisory board members for AstraZeneca R&D Mölndal, and have received research funding from AstraZeneca R&D Mölndal. Per Lundborg and Saga Johansson are employed by AstraZeneca R&D Mölndal. Mari-Ann Wallander was employed by AstraZeneca R&D Mölndal at the time the study was conducted. The above mentioned AstraZeneca employees are involved in a pediatric research program, and participated as independent scientists in the design of the study, analysis of the results and writing of the manuscript.

This study was funded in part by AstraZeneca R&D Mölndal, and was approved by the Multicenter Research Ethics Committee, Cambridgeshire, UK (07/MRE05/31).