Gastroesophageal reflux in children and adolescents. clinical aspects with special respect to food hypersensitivity.

PURPOSE: Gastroesophageal reflux (acid GER), primary and secondary, has a wide spectrum of clinical symptoms and occurs at developmental age. The study objective was to elaborate the clinical profile of symptoms and to determine whether there are any differences in clinical manifestations between the two acid GER conditions, i.e. primary and secondary to cow milk allergy and/or other food allergy (CMA/FA).

MATERIAL AND METHODS: The study involved 264 children of both genders and at various age, with diverse reflux symptoms from one or many organs and with a positive family history of alimentary tract diseases. Based on preliminary diagnostic tests, the children were divided into groups. In 138 children, pathological acid GER, primary and secondary to CMA/FA, was recognized.

RESULTS: The profile of clinical symptoms observed in 264 children with suspected gastroesophageal reflux disease (GERD) was elaborated according to their frequency. Among differentiating symptoms the most common were: vomiting (12.1%), bronchitis (10.9%) and pneumonia (9.6%). In the group of 138 GER children, 32 (23.2%) had monosystemic symptoms, in the other 106 patients (76.8%) many systems were affected. The most frequent reflux symptoms were: in primary GER (group 2)--alimentary tract disorders (28.6%), pneumonia and bronchitis (20.7%) and neurological symptoms with torticollis (7.4%); in secondary GER (group 3)--alimentary tract disorders: vomiting and anxiety/crying (25.2%); pneumonia and bronchitis (19.4%). In 23 children (37%) with secondary GER, typical allergic symptoms were found to coexist. The 138 GER patients underwent allergologic and immunologic tests to confirm the allergic background of symptoms.

CONCLUSION: Clinical symptoms caused by the presence of secondary acid GER are non-specific, being identical or similar to those observed in primary acid GER. Allergologic and immunologic tests are useful to confirm or exclude the relationship between GER and CMA/FA in the study children.