RT Journal Article
SR Electronic
T1 Gastro-oesophageal reflux disease in children with neurological impairment: a retrospective cohort study
JF BMJ Paediatrics Open
JO BMJ Paediatrics Open
FD BMJ Publishing Group Ltd
SP e001577
DO 10.1136/bmjpo-2022-001577
VO 6
IS 1
A1 Tammie Dewan
A1 Justine Turner
A1 Brendan Cord Lethebe
A1 David W Johnson
YR 2022
UL http://bmjpaedsopen.bmj.com/content/6/1/e001577.abstract
AB Objectives To determine the incidence and prevalence of gastro-oesophageal reflux disease (GERD) diagnosis and treatment in children with neurological impairment (NI) along with relationship to key variables.Design This is a population-based retrospective cohort study.Setting This study takes place in Alberta, Canada.Patients Children with NI were identified by hospital-based International Classification of Diseases (ICD) codes from 2006 to 2018.Main outcome measures Incidence and prevalence of a GERD diagnosis identified by: (1) hospital-based ICD-10 codes; (2) specialist claims; (3) dispensation of acid-suppressing medication (ASM). Age, gender, complex chronic conditions (CCC) and technology assistance were covariates.Results Among 10 309 children with NI, 2772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years (50.2–54.1). Increasing numbers of CCCs were associated with a higher risk of GERD. The HR for GERD associated with a gastrostomy tube was 4.56 (95% CI 4.15 to 5.00). Overall, 2486 (24.1%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 dispensations per year (95% CI 16.73 to 17.07). The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.4% (n=351).Conclusions The incidence of GERD in children with NI greatly exceeds that of the general paediatric population. Similarly, incidence rate of medication dispensations was closer to the rates seen in adults particularly in children with multiple CCCs and gastrostomy tubes. Further research is needed to determine the appropriate use of ASMs balancing the potential for adverse effects in this population.Data are available on reasonable request. Requests for data can be directed to TD.