Effective Treatment of FC may Reduce the Burden of GERD in Children

14 Jun, 21

Introduction

Children with functional constipation (FC), frequently suffer with gastroesophageal reflux disease (GERD) symptoms. Studies have reported an overlap between GERD and other functional gastrointestinal disorders in adults, nevertheless; there is limited data on the coexistence of FC and GERD in children. Fecal retention and constipation are known to worsen GERD symptoms in all age groups, consequently; treating constipation may alleviate GERD symptoms.

Aim

To determine the frequency of GERD in children with FC
To assess the improvement level in reflux symptoms in these patients after treating FC

Patient Profile

Children aged 5-18 years presenting with constipation as the main complaint for a period of 2 months or longer (n=94)
None of the study participant had received any treatment for GERD and constipation at the time of enrollment

Methods

Study Design

Prospective study

Assessments and Treatment Strategy

Parental GERD history and atopy history were investigated
Patients with positive GERD symptoms (n=55) underwent twenty-four-hour esophageal pH meter monitoring (24-h pH meter monitoring)
Patients with abnormal acid reflux received conventional treatment for FC (high-fiber diet, behavioral education, and laxatives)
Patients with abnormal acid reflux were re-evaluated for GERD symptoms and weekly defecation frequency, and 24-h pH meter monitoring was repeated at 3 months

Results

The average age of the study population was 12.3 years, and majority of them were females (71%).
The first 24-h pH monitoring was conducted in 55 patients and 23 of these exhibited abnormal acid reflux.
The average age of patients with abnormal acid reflux was 12.3 years and 74% of these patients were females.
The 24-h pH monitoring data at 3 months was available for 21 patients.
Thirteen out of 23 patients were treated with stimulant laxatives during the study period.
Following the treatment of FC, the mean weekly defecation frequency improved significantly (Fig 1).

Fig 1: Weekly defecation frequency during the study

Nearly 52% patients had abnormal reflux index (RI) before treatment, the same reduced to 23% post treatment (Fig 2).

Fig 2: Proportion of patients with abnormal RI during the study

Nine patients (41%) had abnormal acid reflux episodes post-treatment despite increased defecation frequency.
Defecation frequency exhibited a mild-moderate negative correlation with RI and acid reflux episodes.

Conclusions

GERD symptoms frequently coexist in children with FC. Treating constipation and thereby increasing the defecation frequency can improve the reflux symptoms and abnormal acid reflux in such patients.
Physicians should consider the coexistence of these two prevalent problems for better disease management in children.

Eur J Gastroenterol Hepatol. 2017 Nov;29(11):1264-1268.