Gastroesophageal reflux in congenital diaphragmatic hernia survivors: objective diagnostics reveal clinically relevant disease beyond reported symptoms

This is the authors' abstract. We don't add key points for this paper.

PURPOSE: While gastroesophageal reflux disease (GERD) is a frequent comorbidity in congenital diaphragmatic hernia (CDH), there is no consensus about a standardized screening strategy within the speciality. Reported prevalence is heterogeneous, and the role of anti-reflux surgery remains controversial. This single-center study aimed to assess the reliability of symptom inquiry, age-dependent prevalence, the impact of GERD on thriving and lung function, and CDH-inherent predispositions. METHODS: Records of 1250 CDH-patients treated between 2000 and 2022 were reviewed. Associations of GER with symptoms, weight gain, and respiratory function were analyzed. A multivariate regression model was used to identify risk factors. RESULTS: Of 1250 patients, 916/964 survivors were followed for a median of 8.7 years [IQR 4.2-13.4]. Reflux-associated symptoms were reported in 18.0%. Esophagogastroduodenoscopy (EGD) was performed in 85 patients, pH-metry in 58 (50 pH-MII). Pathologic findings were detected in 5.2% of the patients. 115 contrast studies showed reflux in further 8.2%. Anti-reflux surgery was performed in 6.9%. Reported gastrointestinal symptoms were associated with higher 24 h-reflux count (74.9 ± 40.7 vs. 51.0 ± 32.8, p = 0.033). Weight gain correlated negatively with esophagitis severity (r=-0.25, p = 0.04) and acid exposure time (-0.41, p = 0.004). Obstructive lung function correlated with the endoscopic grade of esophagitis (r=-0.52, p = 0.04). Larger CDH-defect size and liver herniation were the only significant predisposing factors for GERD. CONCLUSION: CDH patients, especially those with large defects, are at high risk for GERD, which impairs thriving and lung function. Because symptoms poorly reflect objective findings, structured follow-up including EGD and pH-MII is essential.